LAUSR

Atopic dermatitis (AD) is a chronic, intermittent, and pruritic disease that commonly begins in childhood. The disease is disabling primarily because of excessive pruritus. Topic corticosteroids are the mainstay therapy for this condition, with topical calcineurin inhibitors used as second line. Corticosteroids however, tend to result in negative side effects when used long-term such as skin atrophy, telangiectasias, and striae formation. Topical calcineurin inhibitors (such as tacrolimus or picrolimus) are often associated with burning or stinging upon application. More seriously, they carry a black box warning for lymphoma. A new nonsteroidal drug called Crisaborole (Eucrisa) has been investigated for potential long-term use in AD. It was FDA approved in December 2016. Crisaborole contains a boron atom, which allows for better skin penetration. It works by blocking PDE4, a key regulator in the inflammatory cytokine cascade that degrades cAMP. The new drug has been tested in two double-blind, vehicle controlled randomized clinical trials in which a 2% topical ointment was used twice daily for 28 days in patients aged 2 and older with moderate to severe AD. The results were promising, with patients achieving Investigator’s Static Global Assessment score success (clear/almost clear with secondgrade improvement; AD-301: 32.8 vs. 25.4%, p5 .038; AD-302: 31.4 vs. 18.0%, p< .001), and with more patients reporting clear/almost clear results (51.7 vs. 40.6%, p5 .005; 48.5 vs. 29.7%, p< .001) for each of the two trials respectively (Paller et al., 2016). Of note, no patients reported skin atrophy or telangiectasias. Side effects of the medication were rare and were limited primarily to application site pain (occurred in 4.4% of patients compared to 20– 58% of tacrolimus). Crisaborole is an exciting new nonsteroidal drug that offers a better safety profile, while also being effective. CONFLICT OF INTEREST