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Topical Phosphodiesterase-4 (PDE4) Inhibitor Pregnancy: Caution — limited human data; animal studies showed no teratogenicity; topical use with minimal absorption likely low risk but avoid in first trimester if possible

Crisaborole

Brand names: Staquis

Adult dose

Dose: 2% ointment applied twice daily to affected areas
Route: Topical
Frequency: Twice daily
Max: No formal maximum; apply to all affected areas
Mild-moderate atopic dermatitis (≥2 years); non-steroidal option suitable for face, neck, flexures, and genitalia where steroid atrophy is a concern; apply to affected areas only (not normal skin)

Paediatric dose

Dose: Same as adult application (≥2 years) N/A/kg
Route: Topical
Frequency: Twice daily
Max: Apply to all affected areas
Licensed ≥2 years; MHRA approved; suitable for paediatric face/flexures

Dose adjustments

Renal

No systemic dose adjustment — topical

Hepatic

No systemic dose adjustment — topical

Paediatric weight-based calculator

Licensed ≥2 years; MHRA approved; suitable for paediatric face/flexures

Clinical pearls

  • AD-301 and AD-302 trials (Paller et al. NEJM 2016): crisaborole 2% achieved ISGA 0/1 with ≥2-grade improvement in 32% vs 25% vehicle at day 29 — first non-steroidal, non-calcineurin inhibitor topical treatment for mild-moderate AD; MHRA 2020 approved
  • PDE4 inhibition → increased intracellular cAMP → reduced pro-inflammatory cytokine production (IL-4, IL-13, IL-31, TNF-α); steroid-sparing agent particularly useful for sensitive body sites where long-term steroid use risks atrophy
  • Application site pain: burning/stinging on application is the main tolerability issue — more pronounced on acutely inflamed/eczematous skin; counsel patients it typically reduces after the first few applications as eczema improves
  • Positioned between emollients and topical steroids in AD treatment ladder — suitable as maintenance treatment or for mild flares where steroids are not indicated; also useful as step-down from steroids to maintain remission
  • MHRA 2020: no steroid-related class effects (atrophy, HPA suppression, cataracts) — can be used freely on face, eyelids, and genital skin without the restrictions of topical corticosteroids

Contraindications

  • Known hypersensitivity to crisaborole or peanut/soya (boron-containing compound — check excipients)

Side effects

  • Application site pain/burning/stinging (most common — particularly on first application to inflamed skin)
  • Application site pruritus
  • Systemic absorption minimal at recommended use

Interactions

  • No clinically significant interactions — minimal systemic absorption

Monitoring

  • Eczema severity (EASI/POEM at follow-up)
  • Application site reactions (first visit)
  • Response at 4-8 weeks

Reference: BNFc; BNF 90; AD-301 & AD-302 trials (Paller et al. NEJM 2016); MHRA SPC Staquis 2020; NICE CKS Atopic Eczema; BAD Atopic Eczema Guideline (2023). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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