Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Dermatology and Therapy
Published in: Dermatology and Therapy 3/2023

Open Access 03-02-2023 | Atopic Dermatitis | Review

Pimecrolimus for the Treatment of Atopic Dermatitis in Infants: An Asian Perspective

Authors: Chia-Yu Chu, Tsung-Chieh Yao, I.-Hsin Shih, Chin-Yi Yang, Chan Lee Chin, Sabeera Begum Binti Kader Ibrahim, Suganthi Thevarajah, Leong Kin Fon, Marco Hok-Kung Ho, Chow Chung Mo, Chow Pok Yu, Steven King-Fan Loo, Thomas Luger

Published in: Dermatology and Therapy | Issue 3/2023

Login to get access

Abstract

Atopic dermatitis (AD) is a common chronic, multisystem inflammatory skin disease in pediatric patients. There has been an increase in the incidence of AD in the pediatric population of the Asia–Pacific region. Studies have shown that genetic, epigenetic, environmental and cultural factors may lead to differences in the clinical manifestation and prevalence of AD between races. Early treatment of AD is necessary to prevent the atopic march leading to comorbidities such as asthma and allergic rhinitis. Topical corticosteroids (TCS) are used as first-line therapy for the treatment of AD, but their long-term usage poses a risk to the patient’s health. Pimecrolimus (1%) is a topical calcineurin inhibitor (TCI) that is indicated for the treatment of mild to moderate AD. Pimecrolimus has no apparent increase in adverse events compared to TCS, and it causes less of a burning sensation than tacrolimus. The safety and efficacy of pimecrolimus has been established through various clinical trials; yet, in many Asian countries, the use of pimecrolimus in infants is still restricted due to safety concerns. Based on the available evidence, the expert panel recommends pimecrolimus in infants between 3 months and 2 years of age in the Asian population.
Literature
1.
2.
Tsai TF, Rajagopalan M, Chu CY, et al. Burden of atopic dermatitis in Asia. J Dermatol. 2019;46(10):825–34.PubMedCrossRef
3.
Laughter MR, Maymone MBC, Mashayekhi S, et al. The global burden of atopic dermatitis: lessons from the Global Burden of Disease Study 1990–2017. Br J Dermatol. 2021;184(2):304–9.PubMedCrossRef
4.
Suaini NHA, Tan CPT, Loo EXL, et al. Global differences in atopic dermatitis. Pediatr Allergy Immunol. 2021;32(1):23–33.PubMedCrossRef
5.
Nakahara T, Kido-Nakahara M, Tsuji G, et al. Basics and recent advances in the pathophysiology of atopic dermatitis. J Dermatol. 2021;48(2):130–9.PubMedCrossRef
6.
Luk D, Hon KLE, Dizon MVC, et al. Practical recommendations for the topical treatment of atopic dermatitis in South and East Asia. Dermatol Ther (Heidelb). 2021;11(1):275–91.PubMedCrossRef
7.
Noda S, Suarez-Farinas M, Ungar B, et al. The Asian atopic dermatitis phenotype combines features of atopic dermatitis and psoriasis with increased TH17 polarization. J Allergy Clin Immunol. 2015;136(5):1254–64.PubMedCrossRef
8.
Chan TC, Sanyal RD, Pavel AB, et al. Atopic dermatitis in Chinese patients shows TH2/TH17 skewing with psoriasiform features. J Allergy Clin Immunol. 2018;142(3):1013–7.PubMedCrossRef
9.
Weinberg E. The allergic march. Contin Med Educ. 2010;28(2):64–68.
10.
11.
Tier HL, Balogh EA, Bashyam AM, et al. Tolerability of and adherence to topical treatments in atopic dermatitis: a narrative review. Dermatol Ther (Heidelb). 2021;11(2):415–31.PubMedCrossRef
12.
Stalder JF, Aubert H, Anthoine E, et al. Topical corticosteroid phobia in atopic dermatitis: international feasibility study of the TOPICOP score. Allergy. 2017;72(11):1713–9.
13.
Luger T, Boguniewicz M, Carr W, et al. Pimecrolimus in atopic dermatitis: consensus on safety and the need to allow use in infants. Pediatr Allergy Immunol. 2015;26(4):306–15.PubMedPubMedCentralCrossRef
14.
Sigurgeirsson B, Boznanski A, Todd G, et al. Safety and efficacy of pimecrolimus in atopic dermatitis: a 5-year randomized trial. Pediatrics. 2015;135(4):597–606.PubMedCrossRef
15.
Rubel D, Thirumoorthy T, Soebaryo RW, et al. Consensus guidelines for the management of atopic dermatitis: an Asia-Pacific perspective. J Dermatol. 2013;40(3):160–71.PubMedCrossRef
16.
Kaufmann R, Folster-Holst R, Hoger P, et al. Onset of action of pimecrolimus cream 1% in the treatment of atopic eczema in infants. J Allergy Clin Immunol. 2004;114(5):1183–8.PubMedCrossRef
17.
Staab D, Pariser D, Gottlieb AB, et al. Low systemic absorption and good tolerability of pimecrolimus, administered as 1% cream (Elidel) in infants with atopic dermatitis—a multicenter, 3-week, open-label study. Pediatr Dermatol. 2005;22(5):465–71.PubMedCrossRef
18.
Papp KA, Werfel T, Folster-Holst R, et al. Long-term control of atopic dermatitis with pimecrolimus cream 1% in infants and young children: a two-year study. J Am Acad Dermatol. 2005;52(2):240–6.PubMedCrossRef
19.
Kapp A, Papp K, Bingham A, et al. Long-term management of atopic dermatitis in infants with topical pimecrolimus, a nonsteroid anti-inflammatory drug. J Allergy Clin Immunol. 2002;110(2):277–84.PubMedCrossRef
20.
Ho VC, Gupta A, Kaufmann R, et al. Safety and efficacy of nonsteroid pimecrolimus cream 1% in the treatment of atopic dermatitis in infants. J Pediatr. 2003;142(2):155–62.PubMedCrossRef
21.
22.
Cheng J, Wu JJ, Han G. Epidemiology and characterization of atopic dermatitis in East Asian populations: a systematic review. Dermatol Ther (Heidelb). 2021;11(3):707–17.PubMedCrossRef
23.
24.
Hwang CY, Chen YJ, Lin MW, et al. Prevalence of atopic dermatitis, allergic rhinitis and asthma in Taiwan: a national study 2000 to 2007. Acta Derm Venereol. 2010;90(6):589–94.PubMedCrossRef
25.
Cho Y-T, Hsieh W-T, Chan TC, et al. Prevalence of baseline comorbidities in patients with atopic dermatitis: a population-based cohort study in Taiwan. JAAD Int. 2020;1(1):50–8.
26.
Lavadia AM, Cumagun AT, Palmero L, et al. The ABC topical management of atopic dermatitis in Philippines: expert recommendations. J Drugs Dermatol. 2021;20(1):84–7.
27.
Cheok S, Yee F, Song Ma JY, et al. Prevalence and descriptive epidemiology of atopic dermatitis and its impact on quality of life in Singapore. Br J Dermatol. 2018;178(1):276–7.PubMedCrossRef
28.
Goh YY, Keshavarzi F, Chew YL. Prevalence of atopic dermatitis and pattern of drug therapy in Malaysian children. Dermatitis. 2018;29(3):151–61.PubMedCrossRef
29.
Deckers IA, McLean S, Linssen S, et al. Investigating international time trends in the incidence and prevalence of atopic eczema 1990–2010: a systematic review of epidemiological studies. PLoS ONE. 2012;7(7):e39803.
30.
Torrelo A. Atopic dermatitis in different skin types. What is to know? J Eur Acad Dermatol Venereol. 2014;28(Suppl 3):2–4.PubMedCrossRef
31.
Kaufman BP, Guttman-Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups—variations in epidemiology, genetics, clinical presentation and treatment. Exp Dermatol. 2018;27(4):340–57.
32.
Czarnowicki T, He H, Krueger JG, et al. Atopic dermatitis endotypes and implications for targeted therapeutics. J Allergy Clin Immunol. 2019;143(1):1–11.PubMedCrossRef
33.
Koga C, Kabashima K, Shiraishi N, et al. Possible pathogenic role of Th17 cells for atopic dermatitis. J Invest Dermatol. 2008;128(11):2625–30.PubMedCrossRef
34.
Chen H, Common JE, Haines RL, et al. Wide spectrum of filaggrin-null mutations in atopic dermatitis highlights differences between Singaporean Chinese and European populations. Br J Dermatol. 2011;165(1):106–14.PubMedCrossRef
35.
Kawasaki H, Nagao K, Kubo A, et al. Altered stratum corneum barrier and enhanced percutaneous immune responses in filaggrin-null mice. J Allergy Clin Immunol. 2012;129(6):1538–46.PubMedCrossRef
36.
Ng YT, Chew FT. A systematic review and meta-analysis of risk factors associated with atopic dermatitis in Asia. World Allergy Organ J. 2020;13(11): 100477.PubMedPubMedCentralCrossRef
37.
Suarez-Farinas M, Dhingra N, Gittler J, et al. Intrinsic atopic dermatitis shows similar TH2 and higher TH17 immune activation compared with extrinsic atopic dermatitis. J Allergy Clin Immunol. 2013;132(2):361–70.PubMedPubMedCentralCrossRef
38.
Muizzuddin N, Hellemans L, Van Overloop L, et al. Structural and functional differences in barrier properties of African American, Caucasian and East Asian skin. J Dermatol Sci. 2010;59(2):123–8.PubMedCrossRef
39.
Saeki H, Furue M, Furukawa F, et al. Guidelines for management of atopic dermatitis. J Dermatol. 2009;36(10):563–77.PubMedCrossRef
40.
Kim JE, Kim HJ, Lew BL, et al. Consensus guidelines for the treatment of atopic dermatitis in Korea (part I): general management and topical treatment. Ann Dermatol. 2015;27(5):563–77.
41.
42.
Tsakok T, Marrs T, Mohsin M, et al. Does atopic dermatitis cause food allergy? A systematic review. J Allergy Clin Immunol. 2016;137(4):1071–8.PubMedCrossRef
43.
Dharmage SC, Lowe AJ, Matheson MC, et al. Atopic dermatitis and the atopic march revisited. Allergy. 2014;69(1):17–27.PubMedCrossRef
44.
Boguniewicz M, Schneider L, Leung D, et al. The allergic profile of infants in the SAM study: a large longitudinal study of development of asthma and allergies in patients with atopic dermatitis. J Allergy Clin Immunol. 2007;119(1):S209.CrossRef
45.
Gschwind HP, Waldmeier F, Zollinger M, et al. Pimecrolimus: skin disposition after topical administration in minipigs in vivo and in human skin in vitro. Eur J Pharm Sci. 2008;33(1):9–19.PubMedCrossRef
46.
Billich A, Aschauer H, Aszodi A, et al. Percutaneous absorption of drugs used in atopic eczema: pimecrolimus permeates less through skin than corticosteroids and tacrolimus. Int J Pharm. 2004;269(1):29–35.PubMedCrossRef
47.
Remitz A, De Pita O, Mota A, et al. Position statement: topical calcineurin inhibitors in atopic dermatitis. J Eur Acad Dermatol Venereol. 2018;32(12):2074–82.PubMedCrossRef
48.
Lakhanpaul M, Davies T, Allen BR, et al. Low systemic exposure in infants with atopic dermatitis in a 1-year pharmacokinetic study with pimecrolimus cream 1%. Exp Dermatol. 2006;15(2):138–41.
49.
Paul C, Cork M, Rossi AB, et al. Safety and tolerability of 1% pimecrolimus cream among infants: experience with 1133 patients treated for up to 2 years. Pediatrics. 2006;117(1):e118–28.PubMedCrossRef
50.
Eichenfield LF, Ho V, Matsunaga J, et al. Blood concentrations, tolerability and efficacy of pimecrolimus cream 1% in Japanese infants and children with atopic dermatitis. J Dermatol. 2007;34(4):231–6.PubMedCrossRef
51.
Ling M, Gottlieb A, Pariser D, et al. A randomized study of the safety, absorption and efficacy of pimecrolimus cream 1% applied twice or four times daily in patients with atopic dermatitis. J Dermatolog Treat. 2005;16(3):142–8.PubMedCrossRef
52.
Lubbe J, Friedlander SF, Cribier B, et al. Safety, efficacy, and dosage of 1% pimecrolimus cream for the treatment of atopic dermatitis in daily practice. Am J Clin Dermatol. 2006;7(2):121–31.PubMedCrossRef
53.
Luger T, Augustin M, Lambert J, et al. Unmet medical needs in the treatment of atopic dermatitis in infants: an expert consensus on safety and efficacy of pimecrolimus. Pediatr Allergy Immunol. 2021;32(3):414–24.PubMedCrossRef
54.
Hoetzenecker W, Meingassner JG, Ecker R, et al. Corticosteroids but not pimecrolimus affect viability, maturation and immune function of murine epidermal Langerhans cells. J Invest Dermatol. 2004;122(3):673–84.PubMedCrossRef
55.
Reda AM, Elgendi A, Ebraheem AI, et al. A practical algorithm for topical treatment of atopic dermatitis in the Middle East emphasizing the importance of sensitive skin areas. J Dermatolog Treat. 2019;30(4):366–73.PubMedCrossRef
56.
Langley RG, Eichenfield LF, Lucky AW, et al. Sustained efficacy and safety of pimecrolimus cream 1% when used long-term (up to 26 weeks) to treat children with atopic dermatitis. Pediatr Dermatol. 2008;25(3):301–7.PubMedCrossRef
57.
Wahn U, Bos JD, Goodfield M, et al. Efficacy and safety of pimecrolimus cream in the long-term management of atopic dermatitis in children. Pediatrics. 2002;110(1 Pt 1): e2.PubMedCrossRef
58.
Siegfried EC, Jaworski JC, Hebert AA. Topical calcineurin inhibitors and lymphoma risk: evidence update with implications for daily practice. Am J Clin Dermatol. 2013;14(3):163–78.PubMedPubMedCentralCrossRef
59.
Paller AS, Folster-Holst R, Chen SC, et al. No evidence of increased cancer incidence in children using topical tacrolimus for atopic dermatitis. J Am Acad Dermatol. 2020;83(2):375–81.PubMedCrossRef
60.
Legendre L, Barnetche T, Mazereeuw-Hautier J, et al. Risk of lymphoma in patients with atopic dermatitis and the role of topical treatment: a systematic review and meta-analysis. J Am Acad Dermatol. 2015;72(6):992–1002.PubMedCrossRef
61.
Arellano FM, Wentworth CE, Arana A, et al. Risk of lymphoma following exposure to calcineurin inhibitors and topical steroids in patients with atopic dermatitis. J Invest Dermatol. 2007;127(4):808–16.PubMedCrossRef
62.
Devasenapathy N, Chu A, Wong M, et al. Cancer risk with topical calcineurin inhibitors, pimecrolimus and tacrolimus, for atopic dermatitis: a systematic review and meta-analysis. Lancet Child Adolesc Health. 2023;7(1):13–25.PubMedCrossRef
63.
National Collaborating Centre for Women's and Children's Health. Atopic eczema in children: management of atopic eczema in children from birth up to the age of 12 years. London: RCOG Press; 2007.
64.
Ring J, Mohrenschlager M, Henkel V. The US FDA “black box” warning for topical calcineurin inhibitors: an ongoing controversy. Drug Saf. 2008;31(3):185–98.PubMedCrossRef
65.
Thaci D, Salgo R. Malignancy concerns of topical calcineurin inhibitors for atopic dermatitis: facts and controversies. Clin Dermatol. 2010;28(1):52–6.PubMedCrossRef
66.
Yao X, Song Z-Q, Li W, et al. Guidelines for diagnosis and treatment of atopic dermatitis in China (2020). Int J Dermatol Venereol. 2021;4(1):1–9.
67.
Rajagopalan M, De A, Godse K, et al. Guidelines on management of atopic dermatitis in India: an evidence-based review and an expert consensus. Indian J Dermatol. 2019;64(3):166–81.
68.
Chan TC, Wu NL, Wong LS, et al. Taiwanese Dermatological Association consensus for the management of atopic dermatitis: a 2020 update. J Formos Med Assoc. 2021;120(1 Pt 2):429–42.
69.
Yao TC, Wang IJ, Sun HL, et al. Taiwan guidelines for the diagnosis and management of pediatric atopic dermatitis: consensus statement of the Taiwan Academy of Pediatric Allergy, Asthma and Immunology. J Microbiol Immunol Infect. 2022;55:561–72.
Metadata
Title
Pimecrolimus for the Treatment of Atopic Dermatitis in Infants: An Asian Perspective
Authors
Chia-Yu Chu
Tsung-Chieh Yao
I.-Hsin Shih
Chin-Yi Yang
Chan Lee Chin
Sabeera Begum Binti Kader Ibrahim
Suganthi Thevarajah
Leong Kin Fon
Marco Hok-Kung Ho
Chow Chung Mo
Chow Pok Yu
Steven King-Fan Loo
Thomas Luger
Publication date
03-02-2023
Publisher
Springer Healthcare
Published in
Dermatology and Therapy / Issue 3/2023
Print ISSN: 2193-8210
Electronic ISSN: 2190-9172
DOI
https://doi.org/10.1007/s13555-022-00886-9

Other articles of this Issue 3/2023

Dermatology and Therapy 3/2023 Go to the issue

Original Research

Long-Term Efficacy, Safety, and Drug Survival of Guselkumab in Patients with Psoriasis: Real-World Data from the Czech Republic BIOREP Registry

Original Research

Bimekizumab Efficacy and Safety in Japanese Patients with Plaque Psoriasis in BE VIVID: A Phase 3, Ustekinumab and Placebo-Controlled Study

Commentary

Challenges in the Use of the Treat-to-Target Strategy in Atopic Dermatitis in Latin America: A Case Series Review

Review

Generalized Pustular Psoriasis: A Review on Clinical Characteristics, Diagnosis, and Treatment

Original Research

Dupilumab Demonstrates Rapid Onset of Action in Improving Signs, Symptoms and Quality of Life in Adults with Atopic Dermatitis

Original Research

Potential Predictors of Cardiovascular Risk Improvement in Patients with Hidradenitis Suppurativa Treated with Adalimumab: A Pivotal Study of Factors Associated with Carotid Intima–Media Thickness Reduction
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits