Another 10-year trial, The Pediatric Eczema Elective Registry, is an observational parent-report registry designed to assess the risk of malignancies in 5,000 children aged 217 years who were treated with pimecrolimus for at least 6 weeks.
One recent study found that the patients with severe atopic dermatitis were 2.4 times more likely to develop lymphoma, compared with controls. However, use of pimecrolimus and tacrolimus conferred a protective effect, with odds ratios of 0.8 each (J. Invest. Dermatol. 2007;127:80816).
A separate case-control study of patients with inflammatory dermatitis found that those who used pimecrolimus and tacrolimus had almost a 50% reduction in the risk of developing nonmelanoma skin cancer (Dermatology 2007;214:28995).
The odds ratio of association for nonmelanoma skin cancer decreased as the number of tubes used and the potency of the agent increased. "There was no clear explanation for this," Dr. Dohil said. "There's still a lot of discussion going on."
She added that studies of the blood levels of topical calcineurin inhibitors indicate that they "appear to be negligible when used appropriately."
In clinical practice these agents are commonly used for the face and genital area and for other so-called hot spots with high risk of atrophy.
They are often used in patients with concerns about steroids due to quantity of use in delicate locations, need for constant or near constant therapy, or in those with an adverse event history such as striae or systemic effects.
"Many people feel that topical calcineurin inhibitors can help patients experience a longer flare-free interval and then further transition from this maintenance treatment to maybe just a topical moisturizer if you give enough time for the skin to settle down," Dr. Dohil said.
Dr. Dohil disclosed that the department at Rady has received grant and research support from Hill Pharmaceuticals. She has also received honoraria from Medicis and Dermik.
Many parents find it hard to accept the fact that there is no treatment that completely cures atopic dermatitis. DR. DOHIL