NICE guidance - tacrolimus and pimecrolimus for atopic eczema

Summary points from the NICE guidance are listed below (1):

1. topical tacrolimus and pimecrolimus are not recommended for the treatment of mild atopic eczema or as first-line treatments for atopic eczema of any severity.
   
   
2. topical tacrolimus is recommended, within its licensed indications, as an option for the second-line treatment of moderate to severe atopic eczema in adults and children aged 2 years and older that has not been controlled by topical corticosteroids (see 4), where there is a serious risk of important adverse effects from further topical corticosteroid use, particularly irreversible skin atrophy.
   
   
3. pimecrolimus is recommended, 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 (see 4), where there is a serious risk of important adverse effects from further topical corticosteroid use, particularly irreversible skin atrophy.
   
   
4. for the purposes of the NICE guidance, atopic eczema that has not been controlled by topical corticosteroids refers to disease that has not shown a satisfactory clinical response to adequate use of the maximum strength and potency that is appropriate for the patient's age and the area being treated.
   
   
5. it is recommended that treatment with tacrolimus or pimecrolimus be initiated only by physicians (including general practitioners) with a special interest and experience in dermatology, and only after careful discussion with the patient about the potential risks and benefits of all appropriate second-line treatment options.

Please consult the full guidance for further information.

Notes (2):

• apply topical calcineurin inhibitors to areas of active atopic eczema, which may include areas of broken skin
• topical calcineurin inhibitors should not be used under occlusion (bandages and dressings) for treating atopic eczema in children without specialist dermatological advice
• for facial atopic eczema in children that requires long-term or frequent use of mild topical corticosteroids, consider stepping up treatment to topical calcineurin inhibitors

Reference:

• (1) NICE (August 2004). Tacrolimus and pimecrolimus for atopic eczema
• (2) NICE (June 2023).Atopic eczema in children Management of atopic eczema in children from birth up to the age of 12 years.