Cochrane for Clinicians

Putting Evidence into Practice

Topical Tacrolimus for Eczema

 


FREE PREVIEW. AAFP members and paid subscribers: Log in to get free access. All others: Purchase online access.


FREE PREVIEW. Purchase online access to read the full version of this article.

Am Fam Physician. 2016 Oct 1;94(7):549-550.

Clinical Question

Is topical tacrolimus (Protopic) safe and effective for the treatment of eczema?

Evidence-Based Answer

For children and adults with moderate to severe eczema, topical tacrolimus is an effective, albeit costly, alternative to topical corticosteroids. Both tacrolimus strengths (0.03% and 0.1%) are superior to low-potency topical corticosteroids, whereas tacrolimus 0.1% has similar effectiveness to moderate- to high-potency topical corticosteroids. A mild, self-limited, local burning sensation is common with use.1 (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

Practice Pointers

Although topical corticosteroids are the mainstay of treatment for eczema, they can cause skin atrophy on sensitive areas such as the face, eyelids, genitalia, and intertriginous zones. Topical calcineurin inhibitors such as tacrolimus, pimecrolimus (Elidel), and cyclosporine (Sandimmune) are immunosuppressants that do not cause skin atrophy.

The authors of this Cochrane review evaluated 20 randomized controlled trials with 5,885 participants from North America, Europe, Asia, and Africa.1 The trials compared topical corticosteroids with topical calcineurin inhibitors (primarily tacrolimus) in the treatment of moderate to severe eczema and included adults and children six months or older.

Author disclosure: No relevant financial affiliations.

REFERENCES

1. Cury Martins J, Martins C, Aoki V, Gois AF, Ishii HA, da Silva EM. Topical tacrolimus for atopic dermatitis. Cochrane Database Syst Rev. 2015;(7):CD009864.

2. U.S. Food and Drug Administration. FDA approves updated labeling with boxed warning and medication guide for two eczema drugs, Elidel and Protopic. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108580.htm. Accessed September 9, 2016.

3. Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71(1):116–132.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.



 

Copyright © 2016 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP


Editor's Collections


Related Content


MOST RECENT ISSUE


Dec 1, 2016

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article