OBJECTIVES: The FDA has recently issued a Public Health Advisory to inform health care providers and patients regarding potential carcinogenic risk from use of topical calcineurin inhibitors: tacrolimus and pimecrolimus in atopic dermatitis (AD), in spite of widespread belief in the medical community about the safety of these medications. The objective of this study was to analyze physician and patient related factors associated with physicians' prescribing of calcineurin inhibitors for AD in a nationally representative sample of outpatient visits in US. METHODS: This retrospective, cross sectional study utilized the National Ambulatory Medical Care Survey data from 2000-2003. Office visits were considered to be AD related based on presence of ICD-9 codes and if AD was reported as the reason of visit or if any approved AD medication was prescribed. Weighted logistic regression was used to examine predictors of prescriptions of calcineurin inhibitors versus other AD medications. RESULTS: Topical calcineurin inhibitors constituted 7% of the total 9 million AD medications prescribed in US outpatient settings between 2000 and 2003. Almost 21000 prescriptions were written for children under the age of 2 years. The odds of receiving a prescription for calcineurin inhibitors were approximately 7 times (95%CI: 1.40-31.5) higher for patients of white race as compared to other races. Patients who paid out of pocket had higher odds of receiving a prescription of calcineurin inhibitors as compared to other patients (OR: 4.66; 95%CI: 1.04-20.9). The odds of dermatologists prescribing calcineurin inhibitors were 27 times (95%CI: 9.12-83.09) higher as compared with non-dermatologists. CONCLUSIONS: Prescribing trends indicate that the general medical community seems to recognize the safety of tacrolimus and pimecrolimus despite the warnings put out by the FDA. Rigorous safety and efficacy data collection may be warranted before the use of these medications can be approved for children below two years.