A recent article in Journal of Drugs in Dermatology (December 2008, Volume 7, Issue 12, page 1153-1157) compared two common medications used in atopic dermatitis:  Protopic and Elidel.  These are both nonsteroidal, topical calcineurin inhibitors used for mild to severe atopic dermatitis.  They are useful as steroid-sparing agents, but have their own risk profile.  Despite that, they are generally considered safer then long-term, medium strength topical steroids.  The problem has been to decide which is better.  Since Protopic has an official indication for moderate to severe atopic dermatitis, but Elidel’s indication has been for mild to moderate atopic dermatitis, I have assumed that Protopic is more effective.  Well, it has been proven true.  In this randomized, comparative 6 week study of 98 patients, patients treated with Protopic achieved a 59% improvement in the signs and symptoms of atopic dermatitis, versus a 43% improvement in patients treated with Elidel.  The patients treated with Protopic also cleared faster.  Notice that both groups of patients improved, and within the study some Elidel patients probably improved more then some Protopic patients.  That is what I notice in my practice, and which makes some patients swear Protopic is ineffective. This study, however, demonstrates the importance of a real trial with an adequate number of participants; overall Protopic is a better treatment.  I will use this study to guide my therapeutic choices.