Implications for practice

In relation to the child described in the case scenario, the lack of crucial comparisons makes it impossible for to decide with the child's parents when and how to use topical pimecrolimus. On the basis of the current data, I would only use pimecrolimus in the rare situation of a child with mild-to-moderate atopic eczema who needs to use potent topical steroids almost continuously in order to gain reasonable quality of life, or perhaps in a child whose parents allow their child to suffer terrible symptoms of disease because of an irrational fear of using any form of topical steroids. I might be persuaded to use topical pimecrolimus to prevent flares in childern with brittle disease if early use of 1% hydrocortisone was ineffective.

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