A monocentric, retrospective observational study revealed that the association of tacrolimus with dupilumab is safe and beneficial for adult patients with severe atopic dermatitis. S M Ferrucci et al. aimed to investigate the real-life use of tacrolimus to manage people on dupilumab treatment for atopic dermatitis and to explore the most suitable strategy for this association in a real-life setting.

Out of 342 subjects suffering from atopic dermatitis, only 307 subjects were evaluated. At baseline and following 4, 16 and 52 weeks of intervention with dupilumab, dermatologic quality of life (DLQI),  sleep and itching numerical rating scale (NRS), and eczema area and severity index (EASI) were examined. Overall, 6.5% (n=20) participants used tacrolimus at baseline, 11% after 1 month, 13.5% after 4 months, and 11.3% after 12 months. The mean time to introduce tacrolimus following the commencement of dupilumab was found to be 8.3 ± 0.3 months.

After one month of systemic therapy, a low EASI score was more frequently observed in patients who utilized tacrolimus at baseline (72.2%) compared to patients who did not apply tacrolimus at baseline (55.8%). The non-generalized atopic dermatitis, low age at dupilumab initiation, low DLQI scores, and female sex were associated with an elevated possibility to initiate tacrolimus at any time throughout the study.

Thus, tacrolimus is useful and safe when started early and should be combined with emollients to expedite the response in localized critical areas.