Follow-up Study of FK506 (Tacrolimus) Ointment in Patients with Atopic Dermatitis. What is Recommended as a Maintenance Therapy?

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  • 久留米大学皮膚科におけるプロトピック軟膏の使用経験
  • — What is Recommended as a Maintenance Therapy? —
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A follow-up study of 101 patients with atopic dermatitis who were treated with topical tacrolimus ointment at Kurume University Hospital was carried out to evaluate its efficacy, side effects and outcome after reducing the ointment application dosage. After the erythema in the applied area disappeared, the patients reduced the ointment application dosage randomly in one of three ways; (1) they stopped it completely, (2) they decreased the frequency to once a day, thereafter to once every 2 days and finally stopped all application if the dermatitis did not recur, (3) they decreased the frequency to once every 2 or 3 days, and finally stopped all application. In all groups it was recommended to restart applying the ointment twice a day as soon as any signs of recurrence were encountered. A facial improvement was observed in 93 (93%) out of 99 patients, in the neck in 8 out of 9 patients, and in other areas in 8 out of 12 patients. Skin irritation was reported in 30%, and other adverse drug reactions included acne or folliculitis (6%), Kaposi’s varicelliform eruption (5%) and a worsening of the dermatitis (3%). No severe adverse reaction was observed. After all symptoms disappeared, 5 mild cases in the first group stopped taking tacrolimus abruptly and all of them showed a good course. Most (4/5) of the moderate cases and severe cases had recurrences within 3 days after stopping the application of topical tacrolimus. In the second group, all 14 cases showed good control with once-a-day applications, and 7 of these were later able to reduce the application freguency of the ointment. In the third group 7 of the 8 cases showed a good control of dermatitis when an application of once every 2 or 3 days was maintained. Among them, gradual decrease from once a day to once every 2 days (protocol 2) was the most accepted treatment protocol, which suggested that the patients did not want to experience recurrences due to a reduction of the application freguency.

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