SOURCE: Broeders J, et al. Systematic review and meta-analysis of randomized clinical trials (RCTs) comparing topical calcineurin inhibitors with topical corticosteroids for atopic dermatitis: A 15-year experience. J Am Acad Dermatol 2016;75:410-419.

Atopic dermatitis is a chronic disorder, usually beginning in childhood, that causes significant burden to patients because of unsightly dermatitis, pruritus, and lichenification. Unfortunately, there is no cure for atopic dermatitis; rather, numerous interventions are available to provide reduction in symptoms, or at least temporary periods of remission.

The mainstay of pharmacotherapy for atopic dermatitis has been topical corticosteroids for more than three decades. Although highly successful, concern about local cutaneous toxicity of topical corticosteroids, as well as the potential for systemic effects on the hypothalamic-pituitary-adrenal axis when a high-potency topical corticosteroid is used, has prompted exploration of alternative treatments. Within the past decade, topical calcineurin inhibitors (i.e., pimecrolimus, tacrolimus) have demonstrated efficacy for atopic dermatitis. Because of largely hypothetical concerns about immune dysregulation that might occur with topical calcineurin inhibitors (TCI), current guidelines reserve TCI for second-tier treatment, such as steroid-refractory atopic dermatitis or patients intolerant of topical corticosteroids. Broeders et al compared the efficacy of topical corticosteroids with TCI through a meta-analysis of 12 trials that compared topical corticosteroids to TCI (n = 6,954) in adults and children presenting with atopic dermatitis. Overall efficacy of TCI was slightly greater, but it caused higher rates of non-serious adverse events. The authors concluded that topical corticosteroids should remain the first-line treatment for atopic dermatitis.