Atopic dermatitis affects around 10–20% of babies in developed nations. Topical corticosteroids have been the first-line treatment for flares in recent decades. However, this type of treatment might cause skin atrophy, especially when used on face lesions or over longer periods of time. As a result, new anti-inflammatory topical medications for the treatment of atopic dermatitis in children were required. By blocking the phosphatase calcineurin and reducing the production of proinflammatory cytokines, the topical calcineurin inhibitors tacrolimus and pimecrolimus have an effect on numerous cells of the cutaneous immune system, notably T cells. Topical calcineurin inhibitors were shown to be efficacious on the face, the trunk, and the extremities in both short- and long-term therapy regimens in multiple clinical investigations of children and adults with atopic dermatitis. There was no evidence of tachyphylaxis or rebound. As judged by subjective and objective clinical indications of atopic dermatitis, most patients saw an improvement in their eczema within the first week of therapy. In both children and adults, treatment greatly decreased flares and the need for corticosteroids. More than one-third of all children treated with 0.03% or 0.1% tacrolimus or 1% pimecrolimus experienced treatment success, which is typically described as “good improvement” or “clearing of all lesions.”
In the majority of children with atopic dermatitis, topical administration of pimecrolimus and tacrolimus does not result in substantial blood concentrations of these drugs, and any rise in blood concentrations fades within a few days of therapy. Short- and long-term investigations in individuals with atopic dermatitis found no changes in test values. Mild to moderate irritation symptoms such as burning, erythema, and pruritus, which occurred in up to 20% of all children treated with tacrolimus and 10% of children treated with pimecrolimus and usually faded after a few days, were the most common adverse effect following the application of topical calcineurin inhibitors. Unlike topical corticosteroids, calcineurin inhibitors do not cause skin atrophy, even when used for a lengthy time.
Topical calcineurin inhibitors have been shown to be effective and safe for up to 1 year with pimecrolimus and up to 4 years with tacrolimus. Given the paucity of long-term experience with topical calcineurin inhibitors, routine use of these drugs, especially in children, should be done only after a careful review of each case. It’s also a good idea to use sunscreen.