Atopic dermatitis is a common, chronic, relapsing inflammatory
skin disease frequently affecting infants and children. The worldwide prevalence of
atopic dermatitis is estimated to be 5--20% of the paediatric population. First-line
therapy has generally consisted of dry
skin care, avoidance of triggers, application of topical
corticosteroids, and administration of
antihistamines and oral antibacterials. Topical
corticosteroids improve the lesions of
atopic dermatitis; however, concern on the part of physicians and patients regarding adverse effects has led to reluctance to utilise topical
corticosteroids early and especially for prolonged periods. Topical
immunomodulators (TIMs), including
tacrolimus ointment and
pimecrolimus cream, were recently introduced for the treatment of
atopic dermatitis. Clinical data show that TIMs are effective in
atopic dermatitis, yet do not cause the significant adverse effects associated with topical
corticosteroids. Questions remain regarding the place of TIMs as a treatment for
atopic dermatitis and how to use them most effectively, from both therapeutic and pharmacoeconomic standpoints. Specifically, two major issues remain unresolved: (i) how TIMs measure up to other
therapies, especially topical
corticosteroids; and (ii) how members of the TIM
drug class compare against each other. Previous research has established that
atopic dermatitis has a significant impact on quality of life (QOL) and carries a substantial economic burden. Some studies have also measured the utility of various
atopic dermatitis disease states. While there is a need for further research, early economic studies provide evidence that TIMs positively affect the QOL of patients and families. In certain patients, TIMs may be cost effective and have an acceptable incremental cost utility compared with topical
corticosteroids.Making cost-effectiveness comparisons between
tacrolimus and
pimecrolimus is challenging because there are limited head-to-head comparative data. Given currently available efficacy data, the results of one study suggest that
tacrolimus may be more cost effective than
pimecrolimus in paediatric patients with moderate
atopic dermatitis. The full economic and QOL benefits of both agents are yet to be completely understood. The studies reviewed herein are the first to delineate the pharmacoeconomic benefits of TIMs in
atopic dermatitis, and lay the foundation for future analyses. TIMs represent an exciting advance in the treatment of
atopic dermatitis. Additional research will help determine the proper place of TIMs among the current array of therapeutic options for
atopic dermatitis.