Topical tacrolimus in atopic dermatitis: Effects of ... - Helda - Helsinki.fi

Effects of AD treatment on skin infections
Topical corticosteroids have reduced S. aureus colonization on AD skin in short-term
studies lasting 1 to 8 weeks (Stalder et al. 1994, Hung et al. 2007, Gong et al. 2006).
Tacrolimus 0.1% and 0.03% ointments have been effective in eradication of S. aureus
colonization in short-term studies of 3 to 8 weeks (Pournaras et al. 2002, Park et al.
2005, Hung et al. 2007). Tacrolimus 0.03% was effective but slower in S. aureus
eradication than was fluticasone 0.05% (Hung et al. 2007). Maintenance therapy of AD
with momethasone furoate twice weekly for six months decreased S. aureus as well as
Malassezia (Pityrosporum) colonization in cleared patients (Faergemann et al. 2000).
UVB and PUVA, but not UVA alone, decrease S. aureus colonization and
superantigens (Silva et al. 2006, Jekler et al. 1992, Yoshimura-Mishima et al. 1999).
Ciclosporin has shown some effect on S. aureus colonization and superantigen when
combined with topical betamethasone (Bunikowski et al. 2003).
Infected AD exacerbations require specific treatment of the microbe in
combination with eczema treatment, but no evidence supports the assumption that
antimicrobial treatment of colonized skin will benefit patients in the long-term.
Combining topical antibiotic agents with anti-inflammatory treatment has led to no
further decrease in S. aureus colonization (Hung et al. 2007, Gong et al. 2006, Williams
2000). Neither is there evidence that antifungal treatment’s reducing Malassezia
colonization would relieve AD in the long-term, although treatment periods with an
antifungal agent have had some effect, especially on eczema of the sebaceous areas
(Baker 2006).
Anti-inflammatory treatments (corticosteroids, calcineurin inhibitors) may trigger
HSV infections (Novak & Bieber 2005). In a randomized controlled study of patients
with moderate-to-severe AD, tacrolimus was compared with hydrocortisone-17-butyrate
for 6 months. The prevalence of HSV infections during the first month of the study was
higher in the tacrolimus group (2.9% vs. 1.0%), but the prevalence decreased to a level
comparable to that of corticosteroids during the rest of the study months (1.3% vs.
1.0%) (Reitamo et al. 2005). In a similar study of 48 months, the prevalence of HSV in
the tacrolimus group vanished during follow-up (Hanifin et al. 2005).
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