Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Treatment Options for Children With Atopic Dermatitis

Children with atopic dermatitis (AD) and signs of early sensitization may benefit more from early tacrolimus than corticosteroid treatment, a new study suggests. The interim analysis included 75 patients (55% female) at 1 year of an ongoing 3-year randomized open-label comparative follow-up study of topical tacrolimus vs corticosteroid treatment. Children aged 1-3 years with moderate-to-severe eczema were enrolled. Researchers found:

  • Efficacy parameters, the Eczema Area and Severity Index (EASI), Investigator’s Global Assessment (IGA), transepidermal water loss (TEWL), eczema area, serum total immunoglobulin E (IgE), and the blood eosinophil count showed improvement in both groups.
  • Patients with signs of early sensitization at baseline had statistically lower TEWL at the eczema site and a smaller eczema area at 12 months in the tacrolimus group.


Perala M, et al. Young children with moderate-to-severe atopic dermatitis can be treated safely and effectively with either topical tacrolimus or mild corticosteroids. [Published online ahead of print September 4, 2019]. Acta Paediatr. doi: 10.1111/apa.15001.


This is a small study from Finland that demonstrates that topical therapy alone can make a big impact in young children (aged <4 years) with AD. A group of the children showed better improvement with topical tacrolimus than corticoids, although all improved over time. Other studies have documented in a variety of atopic patients that optimum use of topical therapies is often not achieved. This may be due to either patient or prescriber factors. We should be cognizant that when a young child presents with poorly controlled eczema, more aggressive topical therapy may be a good first choice rather than consideration of systemic therapy. — Joseph Fowler, Jr., MD, Clinical Professor of Dermatology, University of Louisville, KY