Crisaborole: New Treatment for Atopic Dermatitis

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Crisaborole (EUCRISA) is a novel non-steroidal topical ointment for mild to moderate atopic dermatitis (AD, eczema) that was approved in December of 2016. Topical agents are the mainstay of AD therapy and current guidelines recommend both corticosteroids, and topical calcineurin inhibitors (Eichenfield, 2014).

Agents in both of these classes are effective, but may be limited by application reactions and safety concerns with extended use.  Crisaborole is a phosphodiesterase 4 inhibitor (PDE-4) inhibitor with a mechanism of action that has been described for apremilast (Otezla), the oral drug used to treat psoriasis (Moustafa, 2014).

Two identical, vehicle-controlled, double-blind studies showed that crisaborole was significantly more effective than vehicle in achieving ≥2-grade improvements in Investigator’s Static Global Assessment (ISGA) scores in patients with AD (P<0.05 for both studies).

Crisaborole also provided significantly more rapid relief from itch than vehicle. As you know, this is a very important consideration for patients with AD since itch is generally the most bothersome symptom in this common disease.  In addition, itch typically results in scratching which can promote lesion formation and/or transformation to a chronic lichenified state (Turner, 2014).

The majority of treatment-related adverse events with crisaborole were application site pain, primarily reported as burning or stinging. This pain was the only treatment-related adverse events that occurred in ≥1% of patients (Paller, 2016).  Perhaps the main advantage of crisaborole over available topical therapies is avoidance of the potential long-term risks associated with these agents (Zane, 2016).


References

Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71:116-32.

Moustafa F, Feldman SR. A review of phosphodiesterase-inhibition and the potential role for phosphodiesterase 4-inhibitors in clinical dermatology. Dermatol Online J. 2014;20:22608.

Turner MJ, Zhou B. A new itch to scratch for TSLP. Trends Immunol. 2014;35:49-50.