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Atopic Eczema — SCE Dermatology MCQ

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ModerateInflammatory DermatosesAtopic EczemaSCE Dermatology

A 35-year-old woman with severe atopic eczema asks about 'proactive' maintenance therapy with topical calcineurin inhibitors. What does proactive therapy involve?

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Correct answer: B — Applying low-dose topical calcineurin inhibitor to previously affected sites twice weekly even when skin appears clear

Proactive maintenance therapy involves applying topical calcineurin inhibitors (Tacrolimus 0.1% or Pimecrolimus 1%) to previously affected sites twice weekly even during apparent remission, to prevent relapses. This approach has been shown to significantly reduce eczema flare frequency compared to reactive therapy (treating only when flares occur). The evidence supports long-term safety of this approach without increased skin cancer or infection risk. BAD and EADV guidelines recommend proactive TCI maintenance for frequently relapsing eczema. Proactive therapy can also be performed with topical corticosteroids but TCI avoidance of steroid atrophy makes them preferred for long-term maintenance.

Reference: BAD 2020 AD Guidelines; EADV 2022 EuroGuiDerm