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.
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.