Tacrolimus ointment: Utilization patterns in children under age 2 years

Atopic dermatitis (AD) is a common eczematous skin condition; as many as 10-17 percent of all children are affected, and 35-60 percent of affected patients manifest symptoms manifest during the first year of life. Treatment principles for AD in young children involve conservative measures such as avoidance of hot water and environmental irritants, combined with liberal use of emollients after bathing. Low potency topical corticosteroids (TCS) are the current standard of therapy for AD in young children, reserving mid- and high-potency TCS for severe disease. However, complications of long-term use of TCS include skin atrophy, stria formation, telangiectasia, hypopigmentation, secondary infections, steroid acne, allergic contact dermatitis, and miliaria. The pediatric population is also at increased risk for systemic absorption because of their high ratio of skin surface to body mass. Systemic absorption may result in hypothalamic-pituitary-adrenal axis suppression and ultimately growth retardation. Although most topical and systemic corticosteroids are not approved by the Food and Drug Administration for use in children less than 2 years of age, conservative treatment often fails in this age group and frequently patients are treated with TCS, antibiotics, and antihistamines. Tacrolimus ointment is a safe and effective treatment for AD, indicated for children over age 2. This retrospective, multi-center chart review evaluated the utilization patterns (age, sex, response to therapy) of tacrolimus ointment (0.03 % and 0.1 %) in children less than 2-years old with AD seen during a 6-month period at three university-based dermatology practices. Of 38 patient charts reviewed, 37 met inclusion criteria. Fifty-four percent (20/37) were White, 27 percent (10/37) were Black, 8 percent (3/37) were Asian, and 11 percent (4/37) reported other race. Followup visits occurred with 15 patients and all patients (15/15) improved at 1 or more of 23 followup visits. Both concentrations of tacrolimus were effective, and adverse events were uncommon. Tacrolimus ointment appears to be effective and safe for children with AD under age 2.