Indication:Acute treatment of mild to moderate atopic eczema (including flares)
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.
For the purposes of this 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.
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.
NICE TA 82
Tacrolimus and pimecrolimus for atopic eczema August 2004Topical calcineurin inhibitors
Only physicians with a specialist interest and experience in dermatology should start treatment with
tacrolimus or primecrolimus, and only after discussing
1) The risks and benefits of all appropriate second line treatment options
2) That topical calcineurin inhibitors should only be applied to areas of active atopic eczema, which may include areas of broken skin
Topical calcineurin inhibitors for facial atopic eczema in children requiring long-term or frequent use of mild topical corticosteroids
Topical tacrolimus or pimecrolimus should not be used for
For mild atopic eczema
As first-line treatment for atopic eczema of any severity
Under bandages or dressings without specialist dermatological advice
If atopic eczema is not controlled by topical corticosteroids, and if there is risk of important adverse effects from topical corticosteroid treatment, options for treatment with topical calcineurin inhibitors are:
Tacrolimus for moderate to severe atopic eczema in children aged 2 years and over
Pimecrolimus for moderate atopic eczema on the face and neck in children aged 2â16 years. NICE CG57 Atopical eczema in Children December 2007