Therapeutic Implications of the Differential Effects of Topical Corticosteroids and Calcineurin Inhibitors on the Skin Barrier

The effect of tacrolimus compared with betamethasone valerate on the skin barrier in volunteers with quiescent atopic dermatitis

“…The decision to compare tacrolimus, available only as an ointment, against betamethasone valerate in a cream base was pragmatic based on clinical practice, where BMVc is preferred over the ointment base as an alternative to TACo (as reflected in the 2011 U.K. prescription analysis) . The difference in effect of BMVc and TACo on skin barrier function and integrity is unlikely to be a base effect for two reasons: firstly, examples of the damaging effects of prolonged TCS cream use have already been published compared with pimecrolimus cream; and secondly, the scale of the negative effects of BMVc is greater than the differences reported between ointment and cream bases . The effect of TACo here was similar to the effect of pimecrolimus cream reported in these examples.…”

“…TCS represent a safe and effective treatment when used in short courses to treat flares of AD, and should be the first‐line therapy for AD . However, the prolonged use of moderate‐to‐superpotent TCS is associated with reduced epidermal thickness, abnormal keratinocyte differentiation and elevated TEWL . Transmission electron microscopy revealed marked changes in SC structure following TCS treatment, including irregular lipid bilayers and abnormal trafficking of lamellar bodies .…”

“…11 Importantly here, prolonged TCS use has been shown to damage the structure and function of the skin barrier. 12,13 This mechanistic study therefore sought to investigate the effect of tacrolimus 0Á1% ointment (TACo) and betamethasone valerate 0Á1% cream (BMVc) in a head-to-head, within-volunteer, randomized comparison of the properties of the skin barrier in volunteers with a recent history of AD (or quiescent AD). Importantly, these volunteers exhibited clinically stable skin, were free of active signs of AD (clinical inflammation) and had not used anti-inflammatories for 6 months or more.…”

“…TCI are associated with burning/stinging on application . Importantly here, prolonged TCS use has been shown to damage the structure and function of the skin barrier . This mechanistic study therefore sought to investigate the effect of tacrolimus 0·1% ointment (TACo) and betamethasone valerate 0·1% cream (BMVc) in a head‐to‐head, within‐volunteer, randomized comparison of the properties of the skin barrier in volunteers with a recent history of AD (or quiescent AD).…”

The treatment of facial atopic dermatitis in children who are intolerant of, or dependent on, topical corticosteroids: a randomized, controlled clinical trial

“…30 Recently, it has also been shown that treatment with moderately potent TCS for 4 weeks induced damaging effects on healthy stratum corneum, whereas, in the same experiment, no such effects were demonstrated for pimecrolimus cream 1%. 31 The benefit to patients with AD of these findings has still to be investigated in adequately powered, controlled clinical trials.…”