Atopic dermatitis (eczema) - pimecrolimus and tacrolimus

Summary

Tacrolimus and pimecrolimus should not be used to treat mild atopic eczema. When atopic eczema is moderate or severe, tacrolimus and pimecrolimus should not be used as ?first-line? treatments ? that is, they should not be used before other treatments have been tried. But, they may be considered in the circumstances below.

• Tacrolimus may be considered to treat moderate or severe atopic eczema for adults, or children aged 2 years or older, if the maximum strength and potency of topical corticosteroid that is appropriate for the patient?s age and the area being treated has been adequately tried and hasn?t worked, where there is serious risk of important side effects from further use of topical corticosteroids (particularly permanent damage to the skin).
• Pimecrolimus may be considered to treat moderate atopic eczema on the face and neck for children aged between 2 and 16 years if the maximum strength and potency of topical corticosteroid that is appropriate for the patient?s age and the area being treated has been adequately tried and hasn?t worked, where there is serious risk of important side effects from further use of topical corticosteroids (particularly permanent damage to the skin).

Treatment with either tacrolimus or pimecrolimus should only be started by doctors with a special interest and experience in skin diseases (this can include your GP), and only after the pros and cons of these and other appropriate treatment options have been discussed.

Since the NICE guidance on topical pimecrolimus and tacrolimus was issued, following a safety review the European Medicines Evaluation Agency (EMEA) has recommended greater caution in the way these medicines are used in order to reduce potential risks of skin cancer and lymphoma as far as possible.

Patients who are using tacrolimus and pimecrolimus should not stop or modify their treatment without consulting their prescribing healthcare professional.

Further details can be found on the EMEA website.

Documents

For healthcare professionals

• TA82 Atopic dermatitis (eczema) - pimecrolimus and tacrolimus: Quick reference guide
• TA82 Atopic dermatitis (eczema) - pimecrolimus and tacrolimus: Guidance (Word version)
• TA82 Atopic dermatitis (eczema) - pimecrolimus and tacrolimus: Guidance
• Clarification of guidance on the use of tacrolimus and pimecrolimus for atopic eczema

For patients, carers and the public

• TA82 Atopic dermatitis (eczema) - pimecrolimus and tacrolimus: Information for the public

Background information

• TA82 Atopic dermatitis (eczema) - pimecrolimus and tacrolimus: HTA report
• Review proposal
• Review decision- December 2007
• Review proposal for TA82: provisional consultees and commentators
• TA82 Atopic dermatitis (eczema) - pimecrolimus and tacrolimus: comments table

Implementing this guidance

Any further information NICE has produced to help the NHS implement this guideline locally is linked to below:

• None found