Position statement: topical calcineurin inhibitors in atopic dermatitis

Abstract Background Atopic dermatitis ( AD ) is a common inflammatory skin disease in both adults and children. Whilst topical calcineurin inhibitors ( TCI s), tacrolimus ointment and pimecrolimus cream, have proven efficacy for the treatment of AD , it is important to involve experts to obtain their opinion on its optimal treatment. Objective Using a modified Delphi approach, this project aimed to generate consensus amongst experts on the use of TCI s in the treatment of AD , with a focus on the differentiation between tacrolimus and pimecrolimus. Methods Six expert dermatologists from different European countries participated in this project based on their experience with AD and its treatment, which was evaluated by literature analysis and expert opinion. Consensus amongst the experts was generated using a modified Delphi approach, consisting of three distinct phases, during which a web meeting (June 2017), two online rounds of blinded Delphi voting (July–September 2017) and a face‐to‐face meeting (November 2017) were conducted. The consensus statements concerned two main topics: (i) Background of AD ; and (ii) TCI s in AD . Hot topics in the treatment of AD not supported by meta‐analysis, clinical trials or large observational studies were also discussed based on clinical experience. Results In total, 25 consensus statements were defined and validated: eight statements on the general background of AD and 17 statements on the use of TCI s in AD , including their mechanism of action and therapeutic indications in AD , efficacy in adult and paediatric AD patients, pharmacokinetics, incidence of adverse events and safety concerns. Hot topics on the use of TCI s for the treatment of AD included cream vs. ointment, dosages, TCI s contact allergy, burning sensation management, superinfection and vaccination concerns. Conclusion Topical calcineurin inhibitors are a suitable therapy for AD , and selection of the specific TCI should be based on factors which differentiate tacrolimus from pimecrolimus.