When NICE recommends a treatment 'as an option', the NHS must make sure it is available within 3 months of this guidance being published. This means that, if a patient has atopic eczema and the doctor responsible for their care thinks that tacrolimus and pimecrolimus is the right treatment, it should be available for use, in line with NICE's recommendations.
All clinicians who care for people with atopic eczema should review their current practice and policies to take account of the guidance set out in section 1.
Local guidelines or care pathways for people with atopic eczema should incorporate the guidance.
To measure compliance locally with the guidance, the following criteria could be used. Further details on suggestions for audit are presented in appendix A.
Topical tacrolimus and pimecrolimus are not prescribed for the treatment of mild atopic eczema or as first-line treatments for atopic eczema of any severity.
Topical tacrolimus is considered, within its licensed indications, as an option for the second-line treatment of moderate or severe atopic eczema in adults and children aged 2 years and older that has not been controlled by topical corticosteroids, where there is a serious risk of important adverse effects from further topical corticosteroid use, particularly irreversible skin atrophy.
Pimecrolimus is considered, within its licensed indications, as an option for the second-line treatment of moderate atopic eczema on the face and neck in children aged 2 to 16 years that has not been controlled by topical corticosteroids, where there is a serious risk of important adverse effects from further topical corticosteroid use, particularly irreversible skin atrophy.
Treatment with tacrolimus or pimecrolimus is initiated only by a physician with a special interest and experience in dermatology.
Treatment with tacrolimus or pimecrolimus is initiated only after careful discussion between the prescribing physician and the patient about the potential risks and benefits of all appropriate second-line treatment options.
Local clinical audits could also include measurement of compliance with recognised guidelines for the management of atopic eczema and the effectiveness of patient education on the use of treatments for atopic eczema.