Pimecrolimus cream for atopic dermatitis

摘要

Pimecrolimus cream, a new topical immunosuppres-sant, is moderately effective for the short-term treatment of active mild or moderate atopic dermatitis, but has not been compared with the standard therapy in children, which is brief treatment with a mild or moderately potent corticosteroid. In adults, it has been compared to the potent corticosteroid, 0.1% betamethasone valerate, to which its efficacy is inferior. Long-term intermittent use of pimecrolimus cream to prevent progression from early symptoms and signs of atopic dermatitis to flares, has not been compared with the most appropriate conventional therapy for patients with mild or moderate disease, that is, brief treatment with a mild or moderately potent corticosteroid commencing before the flare has become severe or very severe. Pimecrolimus is better than vehicle in preventing progression to severe grades of flare, if topical corticosteroid is withheld until this point, and can reduce the number of days for which a moderately potent corticosteroid is needed. However, such an approach could substantially increase the cost of managing mild or moderate atopic dermatitis, and is unnecessary since conventional therapy is generally effective, safe and cheap. The safety of long-term use of pimecrolimus, in terms of any potential to increase susceptibility to infection or malignancy, needs to be clearly established. Overall, we can find no convincing evidence to justify the use of pimecrolimus in the first-line management of atopic dermatitis. An advertisement for pimecrolimus cream shows a child clearly aged under 2 years ― so implying its use in this age group. This message breaches the licence and shquld be withdrawn and a corrective statement published.