We conducted a randomized, double-blind, placebo-controlled trial to assess the atrophogenicity of tacrolimus ointment. In a combined group of atopic dermatitis patients (n = 14) and healthy volunteers (n = 12), 0.3% tacrolimus, 0.1% tacrolimus, betamethasone-valerate, and a vehicle control were applied in a randomized order to nonsymptomatic, 4 cm x 4 cm regions of abdominal skin. After 7 d of treatment under occlusion, the carboxy- and amino-terminal propeptides of procollagen I (PICP, PINP) and the amino-terminal propeptide of procollagen III (PIIINP) were measured from suction blister fluid with specific radioimmunoassays. In addition, ultrasound measurements of skin thickness were taken. Betamethasone-treated areas showed median PICP, PINP, and PIIINP concentrations of 17.0%, 17.6%, and 39.5% of the vehicle control at the end of the treatment period, respectively, whereas the 0.1% and 0.3% tacrolimus-treated areas showed median concentrations of approximately 100% of the vehicle control (p < 0.001). Betamethasone was also the only treatment to reduce skin thickness; the median decrease in skin thickness was 7.4% relative to 0.1% tacrolimus, 7.1% relative to 0.3% tacrolimus, and 8.8% relative to the vehicle control (p < 0.01). Results for atopic dermatitis patients and healthy volunteers were similar. These findings suggest that tacrolimus does not cause skin atrophy.

Early markers of atopic predisposition are needed for targeting allergy preventive measures to high‐risk infants. An elevated cord serum immunoglobulin E (CS‐IgE) level is considered a risk factor for subsequent allergy in childhood. However, the previous studies have not assessed the predictive value of CS‐IgE in a follow‐up extended to adulthood. We aimed at clarifying whether CS‐IgE is useful in predicting subsequent atopic manifestations up to age 20 yr. A cohort of 200 unselected, full‐term newborns were prospectively followed up from birth to age 20 yr. The CS‐IgE level was successfully measured in 190 subjects at birth. The subjects were re‐examined at ages of 5, 11 and 20 yr with assessment of the occurrence of allergic symptoms during the preceding year, skin prick testing and measurement of serum total IgE. An elevated CS‐IgE level was associated with allergic symptoms and skin prick test positivity at age 5 yr (p = 0.03 and 0.01), with allergic rhinoconjunctivitis at age 20 yr (p = 0.04) and with an elevated serum total IgE at ages of 11 and 20 yr (p = 0.02 and 0.01). The sensitivity of CS‐IgE, i.e. the probability of an elevated CS‐IgE in an infant who subsequently develops atopy, in predicting skin prick test‐verified atopy at ages of 5 and 20 yr was 50% and 26%, respectively. The combination of elevated CS‐IgE and positive family history of allergy was strongly associated with subsequent atopic manifestations. Nevertheless, it showed a reduced sensitivity as compared to CS‐IgE or family history of allergy. We conclude that an elevated CS‐IgE level predicts subsequent atopy up to age 20 yr.

Long-term tacrolimus ointment therapy in patients with AD is nonatrophogenic and reverses corticosteroid-induced skin atrophy.

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Confirmed exposure to water damage was associated with an increase in symptoms. Exposure to water damage caused a significant change in the cellular composition in BAL fluid (lymphocytosis) and blood (decrease of CD19 cells). The depletion of CD19 leucocytes in peripheral blood may indicate an active immune response in the lungs.

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