Both pimecrolimus and tacrolimus are topical calcineurin inhibitors (TCIs) approved for the treatment of atopic eczema. TCIs can be a useful treatment option for people whose eczema is not controlled with the maximum safe strength of topical corticosteroid, or who are at risk of serious side effects such as skin thinning. Only pimecrolimus (10mg/g cream) is authorised for use in children over two years of age. Tacrolimus is only authorised for those over
16 years of age.

TCIs can be used for mild-moderate atopic eczema in situations such as:

• Intolerance to topical corticosteroids
• Lack of effect of topical corticosteroids
• Use on the face and neck where prolonged intermittent treatment with topical corticosteroids may be inappropriate.

The most frequent side effect is a burning and stinging sensation. This effect usually only lasts a few days and patients should be advised to persevere with treatment in these circumstances.

Reflective exercises

• How would you deal with the mother of a young child with severe eczema who tells you that she is reluctant to use topical corticosteroids on her child’s skin because she has read that they can cause severe and lasting skin damage?
• How could you explain the treatment and build her confidence in it?