Topical corticosteroids have long been the mainstay of treatment for dermatitis that does not respond to moisturisers and emollients. Crisaborole is a new non-steroidal option approved for use in mild to moderate atopic dermatitis in patients two years of age and older. Although its precise mechanism of action is not well defined, crisaborole inhibits phosphodiesterase-4 (PDE-4) which leads to reduced secretion of pro-inflammatory cytokines such as tumour necrosis factor-alpha (TNFα).
Crisaborole ointment is applied as a thin layer to the affected areas twice daily. The ointment can be used on all skin areas, including the face and intertriginous areas. Two large randomised, vehicle-controlled clinical trials demonstrate the efficacy of crisaborole. These studies show a significant improvement in disease severity from day eight of treatment and an early and sustained improvement in pruritus in patients treated with crisaborole compared to the vehicle-treated group. The efficacy of crisaborole has not been studied beyond a 28-day treatment course in a controlled trial. However, an open-label extension trial suggests that multiple treatment courses over an extended period may be an effective treatment option that avoids the potential concerns of long-term corticosteroid therapy.
Approximately 25% of the crisaborole dose is absorbed following topical administration. However, the potential for systemic effects is limited as crisaborole is rapidly and substantially metabolised into inactive metabolites. Application site pain was the only treatment-related adverse event associated with crisaborole therapy in two pivotal trials.
- Eichenfield LF, Call RS, Forsha DW, Fowler J, Herbert AA, Spellman M, et al. Long-term safety of crisaborole ointment 2% in children and adults with mild to moderate atopic dermatitis. 2017; 77(4): 641-9.
- Paller AS, Tom WL, Lebwohl MG, Blumenthal RL, Boguniewicz M, Call RS, et al. Efficacy and safety of crisaborole ointment, a novel, nonsteroidal phosphodiesterase 4 (PDE4) inhibitor for the topical treatment of atopic dermatitis (AD) in children and adults. J Am Acad Dermatol. 2016; 75(3): 494-503.
- Staquis™ (Crisaborole) Australian approved product information. Sydney: Pfizer Australia. Approved February 2019.