Principles of management

• Standard initial management of eczema includes:
  • the use of emollients and topical corticosteroids of appropriate potency to treat affected sites
• Regarding topical calcineurin inhibitors:
  • NICE states (1):
    • topical tacrolimus is recommended, within its licensed indications, as an option for the second-line treatment of moderate to severe atopic eczema in adults and children aged 2 years and older that has not been controlled by topical corticosteroids, when there is serious risk of important adverse effects from further topical corticosteroid use (particularly irreversible skin atrophy)
    • pimecrolimus is recommended, within its licensed indications, as an option for the second-line treatment of moderate atopic eczema on the face and neck in children aged 2 years to 16 years that has not been controlled by topical corticosteroids, when there is serious risk of important adverse effects from further topical corticosteroid use, particularly irreversible skin atrophy
  • consult the relevant Summaries of Product Characteristics for licensed indications
• Systemic immunosuppressive treatments are reserved for the treatment of more severe cases of eczema that have been inadequately controlled with topical treatments (such as topical corticosteroids and topical calcineurin inhibitors).

Reference:

1. NICE (June 2023). Atopic eczema in children Management of atopic eczema in children from birth up to the age of 12 years.
2. Sawangjit R et al. Systemic treatments for eczema: a network meta-analysis. Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD013206. DOI:10.1002/14651858.CD013206.pub2