SATURDAY

October 19

SESSION 2

10:45– 11:05

EFFICACY AND SAFETY OF TOPICAL PIMECROLIMUS IN THE TREATMENT OF ATOPIC DERMATITIS

Thomas Luger

Pimecrolimus (Elidel) is a calcineurin inhibitor that has been developed for the topical treatment of inflammatory skin diseases.  This new non-steroid agent offers unique skin selective anti-inflammatory activity that differs from both corticosteroids and tacrolimus.  Pimecrolimus selectively blocks T-lymphocytes and mast cell cytokine production but has not effect on antigen-presenting dendritic cells.  In contrast to topical corticosteroids pimecrolimus has no potential to induce skin atrophy.  Compared with tacrolimus another calcineurin inhibitor pimecrolimus has higher affinity to the skin and permeates the skin to a lesser degree.

  As a consequence there is a lower risk for systemic exposure due to the percutaneous resorption.  Pimecrolimus has only low activity in animal models of systemic immunosuppression but is potent inhibitor of skin inflammation in animal models of allergic contact dermatitis.  In clinical trials pimecrolimus was highly effective both in the short-term treatment of acute symptoms of atopic dermatitis as well as in the long-term management of adults, children and infants.

  A significant improvement of eczema and relief of pruritus was observed within the first week.  In long-term management studies pimecrolimus 1% cream in comparison to a standard care using emollients was found to effectively improve eczema even in severe cases, and to significantly reduce the incidence of recurrences as well as the use of corticosteroids in adults, children as well as infants.  Topical application of pimecrolimus 1% cream was well tolerated and no tachyphylaxis or rebound was observe.  Pharmacocinetic studies demonstrated consistently low blood concentrations of pimecrolimus regardless of age, extent of lesions treated, severity of lesions and duration of therapy.  No clinically significant systemic adverse events have been recorded and there is no evidence for a photocarcinogenic potential, sensitization, cumulative irritation, phototoxicity or photoallergy.  The incidence of application site reactions such as burning and irritation was low.

  In conclusion pimecrolimus 1% cream was found to be a safe and effective first line therapy in adults, children and infants being able to prevent the progression and recurrence of disease and thus offering an excellent therapeutic potential for the long-term management of atopic dermatitis.