Topical agents for the treatment of atopic dermatitis

ABSTRACT

Introduction: Atopic dermatitis (AD) is perhaps the most common inflammatory skin disorder worldwide, with an increasing incidence in developed countries. The mainstay treatment for patients with AD is topical therapies, which are used not only by the mild patients but also by the moderate-to-severe patients, in conjunction with systemic treatment. While topical steroids and calcineurin antagonists are widely used, these are associated with long-term cutaneous adverse effects (AEs) or a black box warning, preventing their chronic use.

Areas covered: The aim of this review is to provide a comprehensive overview of new and upcoming topical therapies currently in development and undergoing clinical trials, as well as their safety and efficacy profiles, and discuss current topicals used in the management of AD.

Expert opinion: AD is a heterogeneous disease with complex pathophysiology. Treatments available to date for AD provide disease control; however, patients struggle to find an optimized therapeutic regimen they may use long term and without severe effects. Novel therapies are currently under investigation, with the hope of shifting the paradigm of AD management from symptom control to disease eradication.

KEYWORDS:

• Atopic dermatitis
• crisaborole
• tapinarof
• topical janus kinase inhibitors
• topical phosphodiaesterase-4 inhibitors
• topical corticosteroids
• topical calcineurin inhibitors

Article highlights

• Atopic dermatitis is the most common inflammatory skin disease with a heterogeneous pathogenesis regulated by a complex interaction between various susceptible genes, host environments, infectious agents, defects in skin barrier function, and immunologic responses.

• Due to the chronic and recurring nature of AD, effective and safe drugs are needed that may be used for long-term disease management.

• To date, there is no cure for AD with the main focus on management of flares and maintenance of remissions.

• Currently available topical anti-inflammatory agents are often insufficient to control severe AD and can be associated with undesirable adverse effects.

• Targeted therapy based on understanding AD disease pathogenesis is expected to be more effective and have fewer side effects than broad immunosuppressants.

• Data from clinical trials on emerging topical therapies demonstrate favorable safety and efficacy profiles, particularly crisaborole, thus presenting new alternatives in the future AD management.

Declaration of interest

E Guttman Yassky is an employee of Mount Sinai and has received research funds (grants paid to the institution) from AbbVie, Celgene, Eli Lilly, Janssen, Medimmune/AstraZeneca, Novartis, Pfizer, Regeneron, Vitae, Glenmark, Galderma, Asana, Innovaderm, Dermira, and UCB. She is also a consultant for Sanofi Aventis, Regeneron, Stiefel/GlaxoSmithKline, MedImmune, Celgene, Anacor, AnaptysBio, Dermira, Galderma, Glenmark, Novartis, Pfizer, Vitae, Leo Pharma, AbbVie, Eli Lilly, Kyowa, Mitsubishi Tanabe, Asana Biosciences, and Promius. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.