Pimecrolimus may be more suitable for long-term treatment of atopic dermatitis than steroids

Genetic defects leading to skin barrier dysfunction are recognized as risk factors for atopic dermatitis (AD). It is essential that drugs applied to patients with AD restore the impaired epidermal barrier to prevent sensitization by environmental allergens.

The study investigated the effect of 2 common treatments, a calcineurin inhibitor (pimecrolimus) and a corticosteroid, on the skin barrier in 15 patients with AD. The patients were treated on one upper limb with pimecrolimus and on the other with betamethasone twice daily for 3 weeks.


Pimecrolimus. Image source: Wikipedia, public domain. Tacrolimus is a 23-membered macrolide lactone discovered in 1984 from the fermentation broth of a Japanese soil sample that contained the bacteria Streptomyces tsukubaensis.

Betamethasone was superior in reducing clinical symptoms and epidermal proliferation; however, it led to epidermal thinning.

Both betamethasone and pimecrolimus improved clinical and biophysical parameters of AD. Because pimecrolimus improved the epidermal barrier and did not cause atrophy, it might be more suitable for long-term treatment of AD.


A suggested approach to topical treatment of moderately severe atopic dermatitis.

Atopic Dermatitis Treatment - Illustrated (click here for full size image).

References:

Different effects of pimecrolimus and betamethasone on the skin barrier in patients with atopic dermatitis. Jensen JM, Pfeiffer S, Witt M, Bräutigam M, Neumann C, Weichenthal M, Schwarz T, Fölster-Holst R, Proksch E. J Allergy Clin Immunol. 2009 May;123(5):1124-33.
Gene expression is differently affected by pimecrolimus and betamethasone in lesional skin of atopic dermatitis. Allergy, 2011.
Drugs acting on immunophilins: Cyclosporine, Tacrolimus, Sirolimus
50% of school children with eczema (atopic dermatitis) may actually have allergic contact dermatitis (study) http://goo.gl/Bq3ZB
Atopic Dermatitis: A Short Review