14. Enthusiastic reports of immune modulatory treatment of atopic dermatitis
In some reviews atopic dermatitis is quoted as being the commonest chronic disease of children in Europe, the US and Japan, and if that is the case it is not surprising that the immune modulators tacrolimus ointment and pimecrolimus cream have been greeted with such enthusiasm. Several thousand patients have been treated with excellent results, and the fact that drug absorption is low obviates any concerns around long-term treatment. Clinical response is typically almost immediate, >30% of treated patients with moderate to severe disease experience >90% improvement over 12 weeks, and 70% have >50% improvement. After one-year of treatment >75% of patients show >90% improvement. This new treatment prevents eczema from relapsing and at the same time controls active eczema. In contrast to steroids, which for decades have been the 'gold-standard' but are not recommended for long-term continuous treatment because of side effects, the tacrolimus and pimecrolimus are lipophilic large molecules which are poorly absorbed during active phases of dermatitis and even less so once skin healing takes place.
Read more:
Ann Allergy Asthma Immunol 2003;91:563-6
Eur J Dermatol 2003;13:455-61
Arch Dis Child 2003;88:969-73
Curr Opin Allergy Clin Immunol 2003;3:359-62