Jurnal Kulit
Jurnal Kulit
Jurnal Kulit
Original Article
Comparative efficacy of topical mometasone
furoate 0.1% cream vs topical tacrolimus 0.03%
ointment in the treatment of atopic dermatitis
Md Alauddin Khan*, Lubna Khondker**, Dilshad Afroze*
Abstract Objective To compare the efficacy of mometasone furoate and tacrolimus in the treatment of
atopic dermatitis.
Methods Sixty patients of atopic dermatitis were treated with mometasone furoate 0.1% (n=30)
and tacrolimus 0.03% (n=30). Both treatments were applied twice daily for 12 weeks. Patients
were followed up monthly. The disease severity assessed by SCORAD index. A 4-point scale
was used to measure the level of response to treatment.
Results Before treatment the respective mean SCORAD was 30.57±13.62 and 30.90±17.17 in
group A and B and at the end of treatment decreased to 11.87±12.04 and 11.20±13.85,
respectively (p>0.05). Percent reduction of severity from baseline to final follow-up was
69.20±23.41 in group A and 74.77±23.30 in group B (p=0.360). At final follow-up 56.7% of
group A and 63.3% of group B achieved excellent response, 13.3% of group A and 16.7% of
group B achieved good response.
Conclusion We conclude that both treatments, mometasone furoate and tacrolimus, are effective
in the treatment of atopic dermatitis.
Key words
Efficacy, mometasone furoate, tacrolimus, atopic dermatitis.
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Journal of Pakistan Association of Dermatologists. 2014;24 (1):57-62.
have many side effects.11 Mometasone furoate medical treatment within 5 days before the
is a medium potency corticosteroid, indicated start of the study, pregnancy and lactation.
for the relief of the inflammatory and pruritic
manifestations of atopic dermatitis.12 Topical Procedure of data collection
calcineurin inhibitors like tacrolimus may be
used as alternate to steroid. Topical tacrolimus A total number of 60 patients were primarily
suppresses inflammation in a similar way to selected and they were randomized using
steroids and is equally as effective as a computer-generated codes into two groups
medium potency steroid.10 It does not cause (group A and group B), each of which
skin thinning or other steroid related side- included 30 patients. Complete history,
effects.13 To the best of my knowledge, no general physical and dermatological
study exploring the efficacy and safety of examinations were done for all enrolled
topical mometasone furoate comparing with patients. History and physical findings were
topical tacrolimus in the treatment of atopic recorded in a structured proforma. Patients,
dermatitis has yet been conducted in who matched the inclusion and exclusion
Bangladesh. So, to know and to treat the criteria and freely gave their informed consent,
patient with atopic dermatitis in an effective were selected for the study.
way, such kind of study was conducted in
Bangladesh. Intervention
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Journal of Pakistan Association of Dermatologists. 2014;24 (1):57-62.
is defined as the subjective symptoms (0-20). Table 1 Demographic and clinical data of patients.
The maximum SCORAD score is 103 (i.e. Group A Group B
(n=30) (n=30)
patients with high score are rated “worse"). Age (years)
2 to10 15 (50.0)# 20 (58.3)*
A 4-point scale was used to measure the level >10 15 (50.0) 10 (33.3)*
Mean ± SD 21.73±4.30 19.70±3.44*
of response to treatment, if >75% clear -
Age at onset 9.37±4.07 7.42±3.12*
excellent response; if 50-75% clear - good Duration of
16.60±17.21 28.20±38.71*
response; if 25-50% clear fair response; if disease (mo)
Erythema 30 (100.0) 30 (100.0)*
<25% clear - poor response.
Papules 30 (100.0) 30 (100.0)*
Excoriation 5 (16.7) 5 (16.7)*
Data analysis Affected sites
Extremities 29 (96.7) 30 (100.0)*
Trunk 2 (6.7) 2 (6.7)*
Data analysis was performed by Statistical Face 1(3.3) 1 (3.3)*
Package for Social Science (SPSS), version- * p>0.05, Unpaired t test.
12. Level of significance (p value) was set at
Table 2 Extent of score of erythematous lesion,
0.05 and confidence interval at 95%.
papules and excoriation in different follow-up.
Group A Group B
Results Erythematous lesion
Baseline 12.77±4.01 11.80 ±3.93
Table 1 shows the clinical characteristics in 1st follow-up 7.80±4.11 7.77 ±4.08
2nd follow-up 6.10±4.03 5.63 ±4.16
the two groups. Both groups were comparable
Final follow-up 4.17±4.02 3.47 ±4.00
in all parameters (p<0.05). Mean age of group Papules
A patients was 21.73±4.30 and group B was Baseline 17.30±10.29 18.57±13.88
1st follow-up 12.40±9.46 13.10± 12.67
19.70±3.44 years. 50% of group A and 58.3%
2nd follow-up 9.97±8.73 10.10± 11.17
of group B were from the 2 to10 year age Final follow-up 7.63±8.08 7.73±9.98
group and 50.0% of group A and 33.3% of Excoriation
Baseline 0.50±1.33 0.53±1.28
group B wee older than 10 years. Mean age of
1st follow-up 0.30±0.88 0.30±0.75
onset of disease was 9.37±4.07 years and 2nd follow-up 0.17±0.59 0.10±0.31
7.42±3.12 years in group A and group B, Final follow-up 0.07±0.37 0.00
respectively (p=0.420). Mean duration of *p>0.05, Unpaired t test.
disease was 16.60±17.21 months and Table 3 SCORAD (Mean of total scoring of Atopic
28.20±38.71 months in group A and group B, dermatitis) in different follow up.
respectively (p=0.139). Group A Group B
Baseline 30.57±13.62 30.90±17.17*
1st follow-up 20.50±13.64 21.17±16.94*
All patients of both groups presented with 2nd follow-up 16.23±12.74 15.83±15.29*
erythema, papules and 16.7% presented with Final follow-up 11.87±12.04 11.20±13.85*
excoriation (p=0.999). Lesions on extremities % reduction from
baseline to final 69.20±23.41 74.77±23.30*
were present in 96.7% of group A and 100.0% follow-up
of group B, lesions on trunk were present in *p>0.05, Unpaired t test.
6.7% and lesions on face in 3.3% (p>0.05).
was 12.77±4.01 and 11.80±3.93, respectively
In Table 2 effect of both treatments on three (p=0.350). At 1st follow-up mean number of
cardinal signs of diseases is compared. Both erythematous lesions in group A and group B
groups showed a comparable improvement was 7.80±4.11 and 7.77±4.08, respectively, at
(p>0.05). At baseline, mean number of 2nd follow-up it was 6.10±4.03 and 5.63±4.16
erythematous lesions in group A and group B and at final follow-up 4.17±4.02 and
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Journal of Pakistan Association of Dermatologists. 2014;24 (1):57-62.
Table 4 Clearance level of disease at different At 1st follow up 3.3% of both group got
follow-ups. excellent response, 10.0% of group A and
Group A Group B
1st follow up 26.7% group B got good response, 60.0% of
Excellent 1 (3.3)# 1 (3.3) group A and 40.0% of group B got fair
Good 3 (10.0) 8 (26.7) response and 26.7% of group A and 30.0% of
Fair 18 (60.0) 12 (40.0)
Poor 8 (26.7) 9 (30.0) group B got poor response (p=0.317).
2nd follow up
Excellent 4 (13.3) 9 (30.0) At 2nd follow up 13.3% of group A and 30.0%
Good 14 (46.7) 12 (40.0)
of group B got excellent response, 46.7% of
Fair 9 (30.0) 7 (13.3)
Poor 3 (10.0) 2 (6.7) group A and 40.0% of group B got good
3rd follow up response, 30.0% of group A and 13.3% of
Excellent 17 (56.7) 19 (63.3) group B got fair response and 10.0% of group
Good 4 (13.3) 5 (16.7)
Fair 7 (23.3) 5 (16.7) A and 6.7% of group B got poor response
Poor 2 (6.7) 1 (3.3) (p=0.470). At final follow up 56.7% of group
*p>0.05, Chi square test. A and 63.3% of group B achieved excellent
response, 13.3% of group A and 16.7% of
3.47±4.00 (p>0.05). At baseline mean number
group B achieved good response, 23.3% of
of papules in group A and group B was
group A and 16.7% of group B achieved fair
17.30±10.29 and 18.57±13.88, respectively
response and 6.7% of group A and 3.3% of
(p=0. 690). At 1st follow-up, mean number of
group B achieved poor response (p=0.828).
papules in group A and group B was
12.40±9.46 and 13.10±12.67, respectively. At
Discussion
2nd follow up, it was 9.97±8.73and
10.10±11.17 and at final follow-up 7.63±8.08 In our study, both treatments showed a
and 7.73±9.98 (p>0.05). At baseline, mean significant improvement in mean scores of
number of excoriation in group A and group B three important clinical signs of AD, mean
was 0.50±1.33 and 0.53±1.28, respectively SCORAD index and level of clearance in their
(p=0. 922). At 1st follow up mean number of respective groups (p<0.05). The improvement
excoriation in group A and group B was in all these parameters was similar in two
0.30±0.88 and 0.30 ± 0.75 respectively, at 2nd groups (p>0.05), showing that both drugs are
follow up it was 0.17±0.59 and 0.10±0.31 and equally effective in children as well adults
at final follow up 0.07±0.37 and 0.00 suffering from AD. The efficacy of both drugs
(p>0.05). is proven in children9,10 but few studies14
directly compared these two drugs in AD.
At baseline mean of total score of atopic
dermatitis was 30.57±13.62 and 30.90±17.17 Gradman et al.14 compared the suppressive
in group A and B, at 1st follow up it was effects of topical mometasone furoate and
20.50±13.64 and 21.17±16.94, respectively in tacrolimus on skin prick testing in 12 children
group A and B, at 2nd follow up it was with atopic eczema before and after 2 weeks of
16.23±12.74 and 15.83±15.29 and at final treatment with topical mometasone furoate and
follow up it was 11.87±12.04 and 11.20±13.85 tacrolimus. Both treatments significantly
respectively in group A and B (p>0.05). suppressed the allergen wheal size.
Percent reduction of severity from base line to
final follow up was 69.20±23.41 in group A Pei et al.15 conducted a study to observe the
and 74.77±23.30 in group B (p=0.360). effectiveness of wet wrap dressings using
0.1% mometasone furoate and 0.005%
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Journal of Pakistan Association of Dermatologists. 2014;24 (1):57-62.
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Journal of Pakistan Association of Dermatologists. 2014;24 (1):57-62.
12. Williams H. New treatments for atopic 16. Schnopp C, Holtmann C, Stock S et al.
dermatitis. BMJ. 2002;324:1533-4. Topical steroids under wet-wrap dressings
13. Lagos BR, Maibach HI. Frequency of in atopic dermatitis—a vehicle-controlled
application of topical corticosteroids: an trial. Dermatology. 2002;204:56-9.
overview. Br J Dermatol. 2003;139:763-6. 17. Hoeger PH, Lee KH, Jautova J et al. The
14. Gradman J, Wolthers OD. Suppressive treatment of facial atopic dermatitis in
effects of topical mometasone furoate and children who are intolerant of, or
tacrolimus on skin prick testing in dependent on, topical corticosteroids: a
children. Pediatr Dermatol. 2008;25:269- randomized, controlled clinical trial. Br J
70. Dermatol. 2009;160:415-22. Epub 2008
15. Pei AY, Chan HH, Ho KM. The Nov 25.
effectiveness of wet wrap dressings using 18. Zuberbier T, Bräutigam M. Long-term
0.1% mometasone furoate and 0.005% management of facial atopic eczema with
fluticasone proprionate ointments in the pimecrolimus cream 1% in paediatric
treatment of moderate to severe atopic patients with mild to moderate disease. J
dermatitis in children. Pediatr Dermatol. Eur Acad Dermatol Venereol.
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