From the Cochrane Library: Topical Tacrolimus for Atopic Dermatitis

摘要

Among chronic skin disorders, atopic dermatitis (AD) demonstrates the greatest negative impact on quality of life for both affected patients and their families, and is associated with anxiety, guilt, and depression [1]. Emotional stress from uncontrolled eczema can be displaced on coworkers, students, and teachers, affecting the entire community. Thus, effective eczema management potentially has farreaching benefits. Eczema is commonly treated with topical corticosteroids (TCS), the long-term use of which may cause dermal atrophy, striae, and hypertrichosis, among other adverse effects [2]. Additionally, patients may suffer from treatment-resistant eczema. Therefore, cost-effective alternative treatments with fewer side-effects may be prudent. A 2015 Cochrane review, “Topical tacrolimus for atopic dermatitis”, assesses the efficacy and safety of the topical calcineurin inhibitors (TCI) tacrolimus and pimecrolimus in comparison to conventional treatments (20 randomized controlled trials, n=5,885) [2]. Significant drug comparison findings are summarized in Table 1. This review found convincing evidence that tacrolimus 0.1% was significantly more effective than low-potency TCS, pimecrolimus 1%, and tacrolimus 0.03% at improving physician- and patient-assessed appearance of eczemaaffected skin in many settings. While results were mainly obtained using the subjective measures mentioned previously, several trials included in the review indicated that tacrolimus significantly improved objective measures such as eczema area and severity index (EASI), quality of life (QoL), and scoring atopic dermatitis (SCORAD) when compared to certain TCS in various settings. However, lack of data on these secondary outcomes limited the completeness of evidence. Unfortunately, since the publication of this Cochrane review only one randomized control trial (RCT) analyzing the efficacy of TCI’s has been published [3]. Despite this RCT validating the findings of this Cochrane review, further research is warranted to investigate the true relationship between TCS and TCI’s utilizing objective standardized criteria.