Topical steroids are a first-line treatment for atopic dermatitis but chronic use can lead to significant adverse effects. A review in the Cochrane Library explores research on the safety and efficacy of the immunomodulator tacrolimus for moderate-to-severe atopic dermatitis compared to other treatments.

Researchers assessed 20 studies of 5,885 patients comparing tacrolimus ointment 0.1% and 0.03% to toptical corticosteroids (TCS) and pimecrolimus 1%. One trial had moderate quality evidence that tacrolimus 0.1% was superior to low-potency TCS by the physician’s assessment; it was marginally better than low-potency TCS on face and neck areas and moderate-potency topical corticosteroids on the trunk and extremities by the physician’s assessment (moderate level of evidence). Patients treated with tacrolimus were nearly twice as likely to improve by the physician’s assessment compared to pimecrolimus 1% (moderate quality of evidence). Tacrolimus 0.1% was shown to reduce the risk of not having an improvement by 18% as evaluated by the physician’s assessment vs. tacrolimus 0.03% (high-quality evidence). There was no difference between tacrolimus 0.1% and moderate-to-potent TCS in the physician’s assessment, and a marginal benefit for tacrolimus 0.1% by the participant’s assessment (low quality of evidence). Tacrolimus and pimecrolimus had similar overall incidence of adverse events; symptoms, such as burning, were generally mild and transient.

Based on this review, the authors conclude that tacrolimus 0.1% is superior to pimecrolimus 1% and tacrolimus 0.03% but not moderate-to-potent TCS. They also noted that tacrolimus 0.03% is better than mild corticosteroids and pimecrolimus. However, the study was limited by a lack of data and the authors warn that these findings should be interpreted cautiously.