Clinical and Cytological Effects of Pimecrolimus Cream 1% after Resolution of Active Atopic Dermatitis Lesions by Topical Corticosteroids: A Randomized Controlled Trial

Abstract

Background: Topical pimecrolimus may maintain remissions of atopic dermatitis (AD) by inhibiting subclinical inflammation. Objective: To evaluate clinical and cytological effects of pimecrolimus in topical corticosteroid-treated and resolved AD lesions. Methods: Patients (n = 67) with resolved AD lesions were randomized to 3-week double-blind treatment with either pimecrolimus cream 1% or vehicle cream. Outcome measures were reduction in Eczema Area and Severity Index (EASI) and number of leukocytes in skin biopsies in all randomized patients who were evaluable at the end of study. Results: The proportion of patients with a localized EASI <2 at the end of study was higher with pimecrolimus cream 1% than with vehicle cream (73.5 vs. 39.4%, respectively). There was a significant decrease in the number of infiltrating CD45+ cells in pimecrolimus cream 1% compared with placebo cream (–88.2 vs. 43.2 cells/mm², respectively, p = 0.047) and a slight but nonsignificant reduction in the number of dermal dendritic cells, Langerhans cells, T cells and macrophages with pimecrolimus versus vehicle cream. Limitations: This was an exploratory study. Conclusion: Topical pimecrolimus was effective at maintaining betamethasone-17α-valerate-induced AD remission by inhibiting recurrences of the inflammatory infiltrate in the skin.

Molecular signatures order the potency of topically applied anti-inflammatory drugs in patients with atopic dermatitis

“…42 Although both topical steroids and TCIs (particularly pimecrolimus) reduced T-cell numbers, LCs were only affected by steroids. 43 Despite its lesser effects, pimecrolimus showed better effects on extracellular lipids and lamellar bodies compared with topical steroids. 44 A recent clinical trial with topical steroids (lacking vehicle control) showed that even a mild-to-moderate steroid, such as triamcinolone acetonide 0.025%, is able to improve clinical indices and also restore key epidermal and immune skin abnormalities in AD lesions.…”

Prevalence and Risk Factors for Xerosis in the Elderly: A Cross-Sectional Epidemiological Study in Primary Care

“…The predisposition to xerosis may also include other skin barrier-related genes such as Spink5, kallikrein 7 or hornerin [19,20,21]. It has been shown that atopic dermatitis may be associated with subclinical inflammation which could contribute to pruritus in elderly patients with xerosis and a history of atopic dermatitis [22]. …”

Treatment for moderate to severe atopic dermatitis in alpine and moderate maritime climates differentially affects helper T cells and memory B cells in children

“…Most studies evaluated lesional skin biopsies and focused on T cell subsets. [35][36][37][38][39][40] Evaluation of alpine climate treatment has been focused on a reduction in eosinophil numbers, but data on T-and B cell subsets are limited. 14,15 Here, we investigate blood T-and B cell subsets in children with moderate to severe AD before and after an intensive 6-week treatment protocol.…”

“…Despite these insights into T cell and B cell abnormalities in disease, data about the effects of treatment on the immune response in patients with AD are limited. Most studies evaluated lesional skin biopsies and focused on T cell subsets . Evaluation of alpine climate treatment has been focused on a reduction in eosinophil numbers, but data on T‐ and B cell subsets are limited …”