Table V.

Recommendations for the use of topical calcineurin inhibitors for the treatment of atopic dermatitis

Topical calcineurin inhibitors (TCIs) are recommended and effective for acute and chronic treatment, as well as maintenance, in both adults and children with atopic dermatitis, and are particularly useful in selected clinical situations (see Box 1).

TCIs are recommended for use on actively affected areas as a steroid-sparing agent for the treatment of AD.

For AD patients under 2 years of age with mild to severe disease, off-label use of 0.03% tacrolimus or 1% pimecrolimus ointment can be recommended.

Pimecrolimus cream and tacrolimus ointment may cause skin burning and pruritus, especially when applied to acutely inflamed skin. Initial treatment of AD patients with topical corticosteroids should be considered to minimize TCI application site reactions. Patients with AD should be counseled about the possibility of these reactions.

Proactive, intermittent use of TCIs as maintenance therapy (2–3 times per week) on areas that commonly flare is recommended to help prevent relapses while reducing the need for topical corticosteroids, and is more effective than the use of emollients alone.

The concomitant use of a topical corticosteroid with a topical calcineurin inhibitor may be recommended for the treatment of atopic dermatitis.

No consistent increases in the prevalence of cutaneous viral infections have been seen with continuous or intermittent use of TCIs for up to 5 years; however, physicians should inform their patients of these theoretical cutaneous risks, given the lack of safety data for longer periods of time.

Clinicians should be aware of the black box warning on the use of TCIs for AD patients and discuss as warranted.

Routine blood monitoring of tacrolimus and pimecrolimus levels in patients with AD who are applying these agents is not recommended at this time.