INTRODUCTION
Atopic dermatitis (AD) is a chronic, inflammatory skin disease that follows a chronic and relapsing course.1 Essential features include pruritus and eczematous lesions that present with a typical morphology and age-associated distribution.2,3 Up to 90% of children with AD have mild or moderate disease.4 Common signs and symptoms include pruritus, erythema, edema, xerosis, erosions/excoriations, oozing and crusting, and lichenification, which vary by age and chronicity of lesions.2 Because of the chronicity, intense symptom burden, and visible nature of the disease, patients with AD frequently have reduced quality of life (QoL) and psychological comorbidities, including depression and anxiety.5 Pruritus is responsible for a significant portion of this burden, which includes the associated impact on sleep quality.2,6
According to the American Academy of Dermatology (2014) and joint guidelines of the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma & Immunology (2013), topical therapies remain standard treatment for AD and provide efficacy while minimizing the potential for systemic adverse events (AEs).7,8 Basic skin care, moisturizers, and trigger avoidance are recommended as initial treatment and are integral to AD therapy, aiming to treat and prevent xerosis, reduce transepidermal water loss (TEWL), reduce signs of AD, and prevent flares.7,8 When the AD is not sufficiently controlled with nonpharmacologic approaches, topical corticosteroids (TCSs) are recommended.7,8 TCSs have been the mainstay of anti-inflammatory therapy for AD for decades and can be used reactively to treat established lesions and proactively to prevent relapse.7 However, safety concerns regarding local and systemic AEs can result in treatment hesitancy in caregivers and patients.7,9 Therefore, appropriate selection of TCS potency, correct application (including duration and location of treatment), and patient education are important.7,8 Topical calcineurin inhibitors (TCIs) are immunosuppressant agents that are recommended as second-line treatment in areas where skin atrophy is a concern (eg, face, eyelids, skin folds), for steroid-nonresponsive AD, when steroids are not advisable, or when a TCS treatment holiday is necessary.7,8 Transient localized burning and itching can occur with TCIs, which can limit their use in some patients.7,8
Crisaborole ointment is a nonsteroidal, phosphodiesterase 4 (PDE4) inhibitor for the treatment of mild-to-moderate AD.
According to the American Academy of Dermatology (2014) and joint guidelines of the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma & Immunology (2013), topical therapies remain standard treatment for AD and provide efficacy while minimizing the potential for systemic adverse events (AEs).7,8 Basic skin care, moisturizers, and trigger avoidance are recommended as initial treatment and are integral to AD therapy, aiming to treat and prevent xerosis, reduce transepidermal water loss (TEWL), reduce signs of AD, and prevent flares.7,8 When the AD is not sufficiently controlled with nonpharmacologic approaches, topical corticosteroids (TCSs) are recommended.7,8 TCSs have been the mainstay of anti-inflammatory therapy for AD for decades and can be used reactively to treat established lesions and proactively to prevent relapse.7 However, safety concerns regarding local and systemic AEs can result in treatment hesitancy in caregivers and patients.7,9 Therefore, appropriate selection of TCS potency, correct application (including duration and location of treatment), and patient education are important.7,8 Topical calcineurin inhibitors (TCIs) are immunosuppressant agents that are recommended as second-line treatment in areas where skin atrophy is a concern (eg, face, eyelids, skin folds), for steroid-nonresponsive AD, when steroids are not advisable, or when a TCS treatment holiday is necessary.7,8 Transient localized burning and itching can occur with TCIs, which can limit their use in some patients.7,8
Crisaborole ointment is a nonsteroidal, phosphodiesterase 4 (PDE4) inhibitor for the treatment of mild-to-moderate AD.
