Recommendations for pimecrolimus 1% cream in the treatment of mild-to-moderate atopic dermatitis: from medical needs to a new treatment algorithm

Abstract

Recommendations for pimecrolimus 1% cream in the treatment of mild-to-moderate atopic dermatitis: from medical needs to a new treatment algorithm Pimecrolimus 1% cream is an effective, non-corticosteroid, topical antiinflammatory treatment for atopic dermatitis (AD). The aim of this article was to review published clinical data that have examined how pimecrolimus can address the medical needs of AD patients. Clinical studies have demonstrated that early treatment with pimecrolimus decreases the progression to disease flares, rapidly improves pruritus and significantly enhances quality of life. Patients find the formulation easy to apply, which may result in improved adherence with the treatment regimen. Pimecrolimus, in contrast to topical corticosteroids (TCSs), does not induce skin atrophy or epidermal barrier dysfunction and is highly effective for the treatment of AD in sensitive skin areas. Furthermore, pimecrolimus reduces the incidence of skin infections compared with TCSs and is not associated with other TCS-related side effects such as striae, telangiectasia and hypothalamic-pituitary-adrenal axis suppression. An additional benefit of pimecrolimus is its substantial steroid sparing effect. On the basis of these data, a new treatment algorithm for patients with mild-to-moderate AD is proposed in which pimecrolimus is recommended as a first line therapy for patients with established mild AD at the first signs and symptoms of disease. Pimecrolimus is also recommended for mild-to-moderate AD after initial treatment with a TCS. After resolution of lesions, maintenance treatment with pimecrolimus may effectively prevent subsequent disease flares. In conclusion, the clinical profile of pimecrolimus suggests that it may be considered the drug of choice for the treatment of mild-tomoderate AD in children as well as adults and particularly in sensitive skin areas.

Heparinoid suppresses Der p‐inducedIL‐1β production by inhibitingERKand p38MAPKpathways in keratinocytes

“…Long‐term use of topical steroids causes adverse effects, such as skin atrophy and infections, and there is a need to prevent inflammation in chronic inflammatory diseases, like AD . Heparinoid is known to have no serious side effects, probably because it cannot exert effects on an intact epidermis.…”

A comparison of international management guidelines for atopic dermatitis

“…Guidelines universally recommend TCI for AD refractory to TCS, requiring chronic TCS, or involving sensitive skin. 15 A number of guidelines recommend both topical tacrolimus and pimecrolimus as second-line therapies, whereas Singaporean, German, and Polish guidelines recommend these medications as first line in areas prone to skin atrophy from TCS, termed "problem areas." 3,4,16 Compared to topical steroids, there is a lack of recommendations for TCI dose and frequency.…”

Atopowe zapalenie skóry – aktualne wytyczne terapeutyczne. Stanowisko ekspertów Sekcji Dermatologicznej Polskiego Towarzystwa Alergologicznego i Sekcji Alergologicznej Polskiego Towarzystwa Dermatologicznego

“…Pimekrolimus w postaci kremu 1% jest zalecany jako leczenie pierwszego rzutu w łagodnym AZS, a jego profil kliniczny sugeruje, że może być rozważany jako leczenie z wyboru w łagodnym i średnim AZS, zarówno u dzieci, jak i dorosłych, szczególnie we wrażliwych rejonach skóry [35].…”

“…W przeciwieństwie do mGKS nie hamują one syntezy kolagenu, nie powodują ścieńczenia naskórka, rozszerzenia naczyń i nie uszkadzają bariery skórnej. Najczęstszym objawem niepożądanym związanym ze stosowaniem mIK jest pieczenie i zaczerwienienie skóry w miejscu aplikacji, które ustępuje po kilku dniach [14,35,36].…”