Proactive Therapy / TCIs — source conflicts

Conflict: [FDA boxed warning, 2006; still on US labels 2026] warns of possible lymphoma and skin-cancer risk with TCIs. [Margolis/PEER, JAMA Dermatol 2015], [Devasenapathy, Lancet Child Adolesc Health 2023] and [Arcuri, JAAD Int 2026] find no increased cancer risk; Health Canada and UK SmPCs have removed/downgraded it. Unresolved — add to open_questions.

Conflict: [Lam et al., JAMA Dermatol 2021] found elevated lymphoma risk with TCIs (RR 1.86 vs non-active; 1.35 vs TCS), as did JOELLE. [Devasenapathy et al., Lancet Child Adolesc Health 2023] found no cancer increase across 110 studies; confounding by eczema severity (Mansfield 2020) is possible. Unresolved — add to open_questions.

Conflict: [NICE TA82/CG57, 2004] recommends pimecrolimus only from age 2. [National Eczema Society, 2023; PCDS, n.d.] state the UK Elidel licence now starts at 3 months. Unresolved — add to open_questions.

Conflict: [Axon et al., BMJ Open 2021] and [Cochrane, Lax 2022] found no evidence of harm from weekend TCS. [Ahuja & Lio, Pediatric Dermatology 2025] report paediatric TSW with use patterns down to twice-weekly. Unresolved — add to open_questions.