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Atopic Eczema — SCE Dermatology MCQ

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HardDermatopharmacologyAtopic EczemaSCE Dermatology

A 30-year-old woman is being counselled about the use of topical Tacrolimus 0.1% ointment for her moderate facial atopic eczema. She asks about the FDA black box warning on calcineurin inhibitors. What is the current clinical consensus regarding cancer risk with topical calcineurin inhibitors?

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Correct answer: C — Current clinical evidence does not show a causal cancer increase at topical doses

The best answer is “Current clinical evidence does not show a causal cancer increase at topical doses”. Eczema treatment is selected by site and severity, with topical corticosteroid or calcineurin-inhibitor safety, infection, adherence, contact allergy and psychosocial effects considered before escalation. The alternatives “safe in adults over 50, when the full phenotype supports it”, “safe for use less than 2 weeks, within an appropriate UK pathway”, “Should be used on the face, after clinicopathological correlation, after specialist assessment”, “High risk of lymphoma — should be avoided, after specialist assessment” are clinically adjacent possibilities, but they do not fit the defining morphology, distribution, histopathology, risk signal or management sequence in this stem.

Reference: NICE CG57 atopic eczema recommendations: https://www.nice.org.uk/guidance/cg57/chapter/Recommendations