Expert Perspectives on Collaborative Management of Atopic Dermatitis - Episode 11

Role of Nonsteroidal Topical Therapies in AD Management 

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Experts in the management of atopic dermatitis review the safety and efficacy of topical calcineurin inhibitors and topical PDE4 inhibitors.

Lawrence F. Eichenfield, MD: Why don’t we shift now? We discussed anti-inflammatory therapy and topical steroids as first-line treatments. We have 3 second-line nonsteroidal agents, 2 of which are topical calcineurin inhibitors [TCIs]. There has been some very nice work that’s come out in studies that have been reassuring about an absence of association of cancer with tacrolimus and pimecrolimus. These were big 10-year registry studies with the tacrolimus priors with pimecrolimus. 

There was also an adult study showing absence of keratinocyte cancers, squamous and basal cell cancers, with exposure to TCIs. It’s reassuring information. Then a topical PDE4 inhibitor, crisaborole. It’s nice that there’s no limitation on duration of use or quantity. It also recently got approved down to 3 months of age—the first nonsteroidal that we’ve had approved in the United States as an anti-inflammatory that’s approved for patients under 2 years of age.

Those are medicines that we’ve put in our regimens of care. They’re not necessarily monotherapy that we use alone, although some people like the nonsteroidal approach. I put them in regimens, especially if I have patients who see the disease come back right away when they’re stopping their topical corticosteroids after a few days. Then I like to do a mix and match between topical nonsteroidals and steroids because I can minimize the adverse effects of what otherwise could occur with the continuous use of topical corticosteroids. It’s something you have to spend some time educating your patients about in terms of what that mix and match means. It’s something that becomes standard practice, along with a push toward long-term disease control and the concept of maintenance of disease.

One of the failures that we get from even great pediatricians is that people are told to not use a medicine for more than 5 days. Then the disease comes back because the extent of the modeling was to treat the inflammation and then go back to your moisturizers. That works for some patients, but it doesn’t for a lot of patients. It makes them uncomfortable that things are occurring all the time.

Transcript Edited for Clarity