Efficacy, security and efficiency of topical immunomodulators (pimecrolimus and tacrolimus) in atopic dermatitis in children and adolescents
Javier González de Diosa, José Cristóbal Buñuel Álvarezb
aServicio de Pediatría. Hospital General Universitario de Alicante. Departamento de Pediatría. Universidad Miguel Hernández. Alicante. ISABIAL-Instituto de Investigación Sanitaria y Biomédica de Alicante. Alicante. España.
bPediatra. Área Básica de Salud Gerona-4. Instituto Catalán de la Salud. Gerona. España.
Correspondence: J González. E-mail: email@example.com
Reference of this article: González de Dios J, Buñuel Álvarez JC. Efficacy, security and efficiency of topical immunomodulators (pimecrolimus and tacrolimus) in atopic dermatitis in children and adolescents. Rev Pediatr Aten Primaria. 2006;8:491-504.
Published in Internet: 30-09-2006
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.
Keywords● Atopic dermatitis ● Pimecrolimus ● Tacrolimus