Dosing of Crisaborole (Eucris) for Mild to Moderate Atopic Dermatitis
Crisaborole 2% ointment should be applied twice daily to affected areas of the skin for the treatment of mild to moderate atopic dermatitis. 1
Recommended Dosing Regimen
- Formulation: 2% ointment
- Frequency: Twice daily application
- Duration:
- Age indication: Approved for patients aged 3 months and above 1
- Application area: Apply to affected areas only
Efficacy Evidence
The recommended twice-daily dosing regimen is supported by multiple clinical trials:
In phase III studies, crisaborole 2% ointment applied twice daily for 28 days demonstrated significantly greater efficacy than vehicle in achieving Investigator's Static Global Assessment success (clear or almost clear with ≥2-grade improvement from baseline) 1
Twice-daily application showed significant improvement in all five component signs and symptoms of atopic dermatitis (erythema, excoriation, exudation, lichenification, and pruritus) 3
Early relief of pruritus was observed as early as day 2 of treatment, with significantly more patients experiencing improvement with crisaborole than with vehicle (34.3% vs 27.3%; p=0.013) 4
Maintenance Therapy Considerations
For long-term management after initial response:
- Once-daily application can be effective for maintenance therapy to reduce flare frequency 2
- In a 52-week study, once-daily maintenance therapy after initial twice-daily treatment resulted in:
- Longer flare-free maintenance (111 vs 30 days compared to vehicle)
- Higher number of flare-free days (234.0 vs 199.4 days)
- Lower number of flares (0.95 vs 1.36) 2
Safety Profile
Crisaborole has a favorable safety profile that supports its use as prescribed:
- Most common adverse effect: Application site reactions (burning, stinging, pain) 1, 5
- Discontinuation rates due to adverse events are low and comparable to placebo (12.1% vs 2.2%) 1
- No new or unexpected safety findings were observed with long-term use 2
- Unlike topical corticosteroids, crisaborole does not have concerns about skin thinning or hypothalamic-pituitary-adrenal axis suppression 5
Clinical Pearls and Caveats
Patient selection: Crisaborole is indicated as an alternative to topical corticosteroids and calcineurin inhibitors for mild to moderate atopic dermatitis 1
Treatment area limitations: Unlike topical JAK inhibitors (e.g., ruxolitinib) which have restrictions on treatment area (≤20% body surface area), crisaborole does not have specific body surface area limitations 1
Potential side effects to monitor: Application site burning/stinging, which is typically mild and transient 1, 5
Systemic absorption: Some patients may experience drowsiness due to systemic absorption, though this is uncommon 1
Allergic contact dermatitis: Rare cases have been reported; discontinue if suspected 1
By following this twice-daily dosing regimen, crisaborole provides effective control of mild to moderate atopic dermatitis with a favorable safety profile suitable for both short-term and long-term management.