Efficacy, security and efficiency of topical immunomodulators (pimecrolimus and tacrolimus) in atopic dermatitis in children and adolescents

Some new items have turned up in atopic dermatitis (DA) treatment during recent years as two new calcioneurin-inhibitor drugs have appeared: tacrolimus (T) and pimecrolimus (P). Several randomized placebo-controlled trials have proved that T and P are effective in the treatment of DA. Nevertheless, the communication of potential severe long-time side effects (cancer), the high cost of both drugs and the need of studies comparing them with conventional treatment (steroids of different strength) make it appropriate to make a bibliographic search to be able to answer to the question: in children and adolescents with DA, topical immunomodulator treatment is more effective, save and/or efficient than steroid treatment? A bibliographic search in TRIP Database and Pub-Med was undertaken and three relevant documents were retrieved: two systematic reviews and one report on evaluation of sanitary technologies. After their critical appraisal we conclude that P and T should not be considered first line drugs in DA treatment and, should never be used in any case in children under two years of age. If corticoid side effects are present or there exists familial ?corticophobia?, they could be used as second line drugs in moderate-severe DA, after informing parents on benefits-risk-cost: current studies support the use of T rather than P. When prescribed they should be used for short periods of time. First line treatment in DA exacerbations is still topical steroids.