Young children with moderate‐to‐severe atopic dermatitis can be treated safely and effectively with either topical tacrolimus or mild corticosteroids

• Published in: Acta Paediatrica Vol. 109; no. 3; pp. 550 - 556
• Main Authors: Perälä, Miia, Ahola, Maria, Mikkola, Tytti, Pelkonen, Anna S., Remitz, Anita, Mäkelä, Mika J.
• Format: Journal Article
• Language: English
• Published: Norway Wiley Subscription Services, Inc 01.03.2020
• Subjects: Administration, Topical; Adrenal Cortex Hormones - therapeutic use; Allergens; Atopic dermatitis; child; Child, Preschool; Children; corticosteroid; Corticosteroids; Dermatitis; Dermatitis, Atopic - drug therapy; Eczema; Eczema - drug therapy; Female; Finland; Follow-Up Studies; Food allergies; Humans; Immunoglobulin A; Immunoglobulin E; Immunosuppressive Agents - therapeutic use; Infant; Leukocytes (eosinophilic); Male; Patients; sensitisation; Tacrolimus; Tacrolimus - therapeutic use; Treatment Outcome; Finland; corticosteroid; atopic dermatitis; tacrolimus; sensitisation; child
• ISSN: 0803-5253; 1651-2227
• DOI: 10.1111/apa.15001

Aim We collected evidence and safety data for topical tacrolimus in small children with atopic dermatitis (AD) and compared the usage with topical corticosteroid. Methods This was an interim analysis of 75 patients (55% female) at 1 year of an ongoing 3‐year randomised open‐label comparative follow‐up study of topical tacrolimus vs corticosteroid treatment. One‐ to three‐year‐old children with moderate‐to‐severe eczema referred to the Skin and Allergy Hospital in Helsinki, Finland, were enrolled. Results Efficacy parameters, the Eczema Area and Severity Index (EASI), Investigator's Global Assessment (IGA), transepidermal water loss (TEWL), eczema area, serum total immunoglobulin E (IgE) and the blood eosinophil count, showed improvement in both groups during the study. However, patients with signs of early sensitisation at baseline (elevated serum total IgE, elevated eosinophil count, positive prick tests or specific IgEs to aero or food allergens) had statistically significantly lower TEWL at the eczema site and a smaller eczema area at 12 months in the tacrolimus group. No severe adverse effects were seen during the treatment. Conclusion Children with AD and signs of early sensitisation appeared to benefit more from early tacrolimus than corticosteroid treatment. Small children may need stronger but nevertheless safe ointment options when treating moderate‐to‐severe AD.