Crisaborole

How it works

It is a phosphodiesterase-4 (PDE4) inhibitor that raises intracellular cyclic AMP, thereby reducing release of pro-inflammatory cytokines involved in atopic inflammation.

Prescribing in practice

• Application-site burning or stinging is the most common adverse effect and can affect adherence, particularly early in treatment.
• It is a steroid-free option suited to sensitive sites such as the face and flexures where prolonged steroid use is undesirable.
• Reassess the diagnosis and treatment if eczema does not improve within an appropriate period, and treat any superimposed infection.

Monitoring

Monitoring is clinical, assessing eczema control and tolerability at the application site.

Counselling the patient

• Apply a thin layer to affected areas and continue emollients as usual.
• A short-lived burning or stinging sensation on application is common and usually settles.
• Seek advice if the skin becomes more inflamed or shows signs of infection.

Evidence & guidelines

Crisaborole is positioned as a topical steroid-sparing option for mild to moderate atopic dermatitis based on its PDE4-inhibitor trial programme.