From the Guidelines
For non-steroidal treatment of atopic dermatitis, dupilumab, abrocitinib, baricitinib, and upadacitinib are recommended prescription medications, as supported by the latest evidence from the Journal of the American Academy of Dermatology 1. These medications are particularly useful for patients with severe or widespread atopic dermatitis, or those whose disease is refractory to optimized topical therapy.
- Dupilumab is an injectable biologic medication that has been shown to be effective in reducing inflammation and improving symptoms of atopic dermatitis.
- Abrocitinib, baricitinib, and upadacitinib are oral Janus kinase inhibitors that have been found to be highly effective in treating moderate-to-severe atopic dermatitis, with a fast onset of action 2. It is essential to note that the decision to initiate these advanced therapies should be made using shared decision-making between patients and clinicians, taking into account the severity of atopic dermatitis, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1. Additionally, patients may need to use evidence-based topical therapies, including emollients and topical anti-inflammatory medications, concomitantly with these systemic therapies. The long-term safety of these systemic medications for atopic dermatitis should be continuously monitored with rigorous pharmacovigilance studies 1.
From the FDA Drug Label
ELIDEL ® (pimecrolimus) Cream 1% is indicated as second-line therapy for the short-term and non-continuous chronic treatment of mild to moderate atopic dermatitis in non-immunocompromised adults and children 2 years of age and older, who have failed to respond adequately to other topical prescription treatments, or when those treatments are not advisable.
- Pimecrolimus (TOP) is a recommended prescription medicine for non-steroidal for-skin atopic dermatitis, specifically as a second-line therapy for mild to moderate cases in adults and children 2 years of age and older 3.
- It is used when other topical prescription treatments have failed or are not advisable.
- Key points about pimecrolimus include its use for mild to moderate atopic dermatitis and its status as a non-steroidal option.
From the Research
Non-Steroidal Prescription Medicines for Atopic Dermatitis
- Tacrolimus ointment is a topical inhibitor of the phosphatase calcineurin, approved in the United States for use in the treatment of atopic dermatitis 4.
- Pimecrolimus, a newer calcineurin inhibitor closely related to tacrolimus, is also being developed for atopic dermatitis therapy 4.
- Topical calcineurin inhibitors, including pimecrolimus and tacrolimus, have been shown to be effective in achieving lesion clearance and reducing relapse when used long-term and proactively 5.
- Crisaborole, a phosphodiesterase 4 (PDE4) inhibitor, has also been shown to be effective in lesion clearance and symptom management 5.
- These non-steroidal topical therapies provide a safe treatment alternative to topical corticosteroids, with low systemic absorption and no increased risk of systemic adverse events or malignancy 5, 6.
Characteristics of Non-Steroidal Prescription Medicines
- Tacrolimus and pimecrolimus have an advantage over hydrocortisone derivatives in that they do not cause dermal atrophy 4.
- Topical calcineurin inhibitors have been associated with application-site discomfort, pain, or pruritus as the most commonly reported treatment-related adverse event 5.
- The US Food and Drug Administration (FDA) black box warning for topical calcineurin inhibitors remains, but studies have not shown an increased risk of malignancy 5.
Treatment Options
- A multi-therapeutic approach that incorporates short-term management of flares and longer-term strategies to prolong the time between flares is needed for the treatment of atopic dermatitis 6.
- Emollients, topical corticosteroids, and topical calcineurin inhibitors are among the treatment options available for atopic dermatitis 6.
- Non-steroidal approaches, including biologics and Janus kinase inhibitors, may be possible and preferred by certain patients 7.