Non-steroidal topical immunomodulators provide skin-selective, self-limiting treatment in atopic dermatitis

Topical corticosteroids are the mainstay of treatment for atopic dermatitis; however, their clinical utility is limited by potential side effects. Recently, the steroid-free topical immunomodulators tacrolimus ointment and pimecrolimus cream have become available. These agents provide effective treatment without causing skin atrophy or other steroidal side effects, and their physiochemical properties, such as relatively large molecular size and high lipophilicity, limit diffusion through skin and into the bloodstream, providing skin-selective treatment. Clinical trials with more than 1,700 paediatric and adult patients have demonstrated that treatment with either agent is associated with minimal systemic absorption of tacrolimus or pimecrolimus. Additionally, studies have shown that percutaneous absorption of tacrolimus decreases as treatment continues and clinical improvement occurs. This self-limiting facet of the treatment, together with the skin-selectivity of topical immunomodulators, is reflected in the good safety and tolerability profiles of these agents, which promise to significantly improve the long-term management of atopic dermatitis.