ABSTRACT
Atopic dermatitis (AD) is the most common inflammatory skin disease, affecting 20% of children and up to 4% of adults. The pathogenesis is multifactorial with a dominant genetic component, but in addition having environmental, bacterial, dietary, epidermal barrier and immunological elements. Since 1952, topical corticosteroids, have been the mainstay of treating the inflammatory component of the disease. Attempts have been made to improve receptor targeting of corticosteroids, but there has been no escape from the link between increased potency and side-effects. The availability of tacrolimus ointment and pimecrolimus cream for moderate to severe and mild to moderate AD, respectively, has revolutionized the topical treatment of this disease1,2. Tacrolimus ointment is as efficacious as potent topical corticosteroids, whereas pimecrolimus cream is as efficacious as mild to moderately potent topical corticosteroids3. Neither treatment produces cutaneous atrophy, striae or pigmentary changes, and they can be used on the face without fear of inducing glaucoma. These treatments will probably reduce the need for systemic therapy, but for those patients with resistant disease, treatment with phototherapy (ultraviolet B (UVB), UVA1, psoralen and ultraviolet A (PUVA)), cyclosporin, mycophenolate or azathioprine would be appropriate. Nevertheless, there are still patients with recalcitrant disease, and intravenous immunoglobulin (IVIG) has been reported to be beneficial in case reports and clinical trials.
