A new alternative to topical steroid treatments for eczema will no longer be available from GPs if new NICE recommendations, published in final draft today, go ahead: Appraisal Consultation Document (ACD): Tacrolimus and pimecrolimus for atopic eczema .

Tacrolimus (Protopic), indicated for second line use in moderate to severe eczema, and pimecrolimus (Elidel), indicated for first line use in mild to moderate eczema, are the first new class of treatments for eczema to be available in 40 years.

The NICE recommendation that tacrolimus be available as a second line treatment for moderate to severe atopic eczema is welcome. However, the NICE refusal to recommend that pimecrolimus be available for the treatment of atopic eczema will come as a major concern to patients and families struggling on a daily basis to keep this frequently miserable condition under control.

Pimecrolimus appears to have been turned down because there is insufficient evidence comparing it with topical corticosteroids, which until now have been the first line treatment for ‘flare ups’ of eczema. Yet, while acknowledging topical corticosteroids side effects such as skin thinning are more likely to occur in areas such as the face and flexures, the NICE consultation fails to recognise an alternative in pimecrolimus.

“Topical corticosteroids use is not recommended in the face and flexures because of the increased risk of skin thinning,” comments Peter Lapsley, chief executive, Skin Care Campaign.

“Pimecrolimus and tacrolimus represent exciting treatment options for face and flexures, meeting a currently un-met demand. A patient should not need to be in the ‘moderate to severe’ category to qualify to receive this new class of treatment.

A secondary concern is ‘steroid-phobia’. Lapsley explains: “Rightly or wrongly,” steroid-phobia exists and it results in some eczema patients and carers under-using or wasting prescribed steroid treatments because they are scared of unwanted side effects.

Lapsley concludes: “In any situation where a patient fails to control their condition effectively, it results in unnecessary suffering and, ultimately, increased cost to the NHS.”

The Skin Care Campaign is calling on NICE to review urgently its refusal to fund pimecrolimus. It recommends that because everybody’s skin is different and different people react differently to different treatments, the widest possible range of treatments should be available on prescription at appropriate levels within the NHS.

The Skin Care Campaign is an umbrella organisation representing the interests of all people with skin diseases in the UK . Established in 1992, it is a subsidiary of the National Eczema Society, a registered charity, which is also one of its members.