Key points

• 1% pimecrolimus cream is more effective than vehicle cream in children and adults with mild-to-moderate atopic eczema.

• 1% pimecrolimus does not cause skin thinning.

• 1% pimecrolimus cream is much less effective than topical betamethasone valerate in atopic eczema. It has not been compared against 1% hydrocortisone.

• It is not known how pimecrolimus compares against topical tacrolimus in people with atopic eczema.

• It is not known whether pimecrolimus is effective in people with atopic eczema not well controlled with topical steroids.

• The cost-effectiveness of pimecrolimus versus standard therapy is not known.

• It is not known whether early treatment with topical tacrolimus is any better than early treatment with a weak topical steroid such as 1% hydrocortisone in preventing more severe flares that require potent steroids.

• Independent studies are needed to compare the cost-effectiveness of pimecrolimus versus standard bursts of topical steroids in the short-term control of mild atopic eczema in children and to see whether early use of either treatment approach improves disease control over a longer period.

• Until such crucial comparisons become available, the role of topical pimecrolimus

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