Intended for healthcare professionals


New treatments for atopic dermatitis

BMJ 2002; 324 doi: (Published 29 June 2002) Cite this as: BMJ 2002;324:1533

Good news, but when and how to use tacrolimus and pimecrolimus is a muddle

  1. Hywel Williams (, professor of dermato-epidemiology
  1. Centre of Evidence-Based Dermatology, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2UH

    Atopic dermatitis now affects 15% to 20% of children in developed countries, and prevalence in cities in developing countries undergoing rapid demographic changes is quickly following suit.1 Most cases of atopic dermatitis in a given community are mild, but children with moderate to severe disease can have continuous itching and associated loss of sleep. The social stigma of a visible skin disease can also be soul destroying for both patient and family. A few studies have suggested that some degree of prevention of the disease is possible,2 although these measures have not been taken up widely. In the absence of any treatment that is known to alter the clinical course of the disease, most treatment is aimed at reducing symptoms and signs. After a relative lull of almost 40 years, new drugs—tacrolimus and pimecrolimus—have appeared that offer different approaches to managing this miserable disease. Do they work? Are they safe? And how do they compare with existing treatments?

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    A suitable place to start putting the 47 existing treatments into context is the NHS health technology assessment systematic review of randomised controlled trials for atopic dermatitis.3 This report concluded that the evidence base for the treatment of atopic dermatitis is characterised by poor standards of reporting of clinical trials and a lack of common outcome measures that are important to patients. The direction of trials over the past 40 years …

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