Given the lack of crucial comparisons surrounding the introduction of topical tacrolimus, physicians and patients are left guessing as to how and when it should be used. The lack of skin thinning effect may point to it being particularly useful when patients with moderate-to-severe disease are "stuck" on their topical steroid preparations and have to use such preparations almost continuously. Topical tacrolimus may be particularly useful for resistant facial atopic eczema, for similar reasons. Physicians should resist using such a preparation as a "steroid alternative" until more relevant RCT and safety data becomes available.
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