Ascomycin: an advance in the management of atopic dermatitis

Professor Griffiths is an advisor to Novartis Pharmaceuticals U.K. Ltd., manufacturers of ascomycin. The demonstration that topical glucocorticosteroids are an effective treatment for atopic dermatitis1 was one of the major breakthroughs in dermatological therapy in the past 50 years. Any new therapy that has marked efficacy is subject to an initial flurry of overuse with scant regard for potential side‐effects, particularly if used in areas with a previously unmet need. As a consequence, the undoubted efficacy of topical glucocorticosteroids has been overshadowed by a litany of side‐effects ranging from suppression of the hypothalamic–pituitary axis to cutaneous atrophy and striae. Unfortunately, this had reached such a stage at the end of the 20th century that, in the UK at least, a steroid phobia2 reigned, particularly amongst patients, parents of children with atopic dermatitis and general practitioners. As a consequence many patients were opting for the seemingly safer haven of alternative or herbal remedies, not all of which are steroid‐free3 and are certainly more expensive. Thus the opportunity was ripe for the introduction of a topical immunosuppressive or immunomodulator that was not a steroid.