Tacrolimus Ointment Compared To Steroid Ointment For Eyelid Dermatitis In Patients With Atopic Keratoconjunctivitis

Abstract

Purpose: : Corticosteroid ointment is the conventional eczema treatment in atopic dermatitis patients. Lately, tacrolimus ointment has become a viable second line treatment in atopic dermatitis. The main objective of this explorative study was to evaluate if tacrolimus ointment could be safer, with special reference to the intraocular pressure, than corticosteroid ointment in the treatment of eyelid eczema in patients with atopic keratoconjunctivitis. Secondary aims were to compare the effects of the treatments on eyelid eczema and their potential impact on ocular surface inflammation.

Methods: : Tacrolimus 0.1% ointment and clobetasone butyrate 0.05% ointment were compared in a double–masked crossover study. Twenty–five atopic keratoconjunctivitis patients were included. Each ointment was applied twice daily for three weeks, with two weeks of washout before, between and after treatments. Efficacy was determined by the physician's examination and the patients own scoring of signs and symptoms. Cytology and cytokine measurements were performed on tear samples. Safety parameters were intraocular pressure, presence of bacteria and fungi and the patients’ reports of adverse events. The validity of the cross over design was explored with analysis of variance and the effect of each medication was calculated with paired t–test and Wilcoxon paired test.

Results: : Twenty patients completed the study. Both treatments were effective in reducing signs and symptoms of eyelid eczema, with a near superior benefit for tacrolimus in terms of eczema (total skin score) signs (P = 0.05). Eye surface parameters were not proven significantly affected by either treatment. No serious adverse events occurred and interestingly intraocular pressure was not evidently affected by either treatment.

Conclusions: : Tacrolimus 0.1% ointment is a promising alternative therapy for eyelid eczema in atopic keratoconjunctivitis patients. Long–term studies are needed to further determine the value of tacrolimus in this patient group.

Keywords: conjunctivitis • inflammation • eyelid