EFFICACY

In a case series study of 728 patients (aged 0-85 years), 21.5% who used AR/CASM were completely clear after 180 days. Most had some improvement within the first 30 days of treatment.

SAFETY

Possible side effects include those associated with use of topical corticosteroids and topical antibiotics.

EVIDENCE LEVEL

There is limited published evidence for AR/CASM. There are two published studies (case series).

AVAILABILITY

Used “off-label” and available in most countries.

EFFICACY

In two randomized control trials of 1,522 patients (aged 2 years and older) with mild to moderate eczema, 48-52% of patients taking the medication (n=1016) experienced clear or almost clear skin after 4 weeks (measured by the Investigator's Static Global Assessment) compared to 30-41% of patients who used moisturizer alone.

SAFETY

The most common side effects from the study related to the treatment was application site burning and stinging which occurred in 4% of study subjects.

EVIDENCE LEVEL

Crisaborole has been well studied for use in eczema with over 100 studies now published on its use for eczema.

AVAILABILITY

Crisaborole has been approved in the US & Canada for ages 3 months and older and Australia for ages 2 years and older. For help paying for this treatment see: Pfizer Dermatology Patient Access.

EFFICACY

In an early clinical trial of 136 patients (aged 12 years and older) with mild to moderate eczema, 52% of patients using the highest dosage of the cream achieved a 75% improvement in their eczema severity after 4 weeks (as measured by the EASI).

According to one study, after 4 weeks, 52-55% experienced significant reductions in daily itch (4 points or greater on the Pruritus NRS score) depending on the dosage of roflumilast.

SAFETY

Side effects of mild rash and moderate application site pain occurred in 2.2% of patients receiving the treatment.

EVIDENCE LEVEL

There are limited published studies on Roflumilast.

AVAILABILITY

Approved in the US for individuals ages 6 years and older with mild to moderate eczema.

EFFICACY

In two studies lasting eight weeks involving 631 and 618 patients with mild-to-moderate eczema (aged 12 years and older), 62% of patients using the highest dosage had a 75% improvement in their eczema severity (as measured by the EASI). In addition, 40-50% of patients experienced significant itch reductions (a 4-point drop on the Pruritus NRS score) depending on the dosage of ruxolitinib.

In a long-term safety study, 1072 patients (aged 12 years and older) continued treatment for an additional 44 weeks. Among those who applied the 0.75% ruxolitinib cream and the 1.5% ruxolitinib cream, the mean number of days until the first retreatment was 8 days and 12 days respectively.

SAFETY

Application site reactions, such as stinging/burning, were infrequent (<1%) in the published studies and lower in those using Ruxolitinib cream compared with those using a non-medicated cream.

The most common side effects reported in a study included: the common cold (3%), diarrhea (1%), bronchitis (1%), ear infection (1%), eosinophil count increased (1%), urticaria (1%), folliculitis (1%), tonsillitis (1%), and rhinorrhea (1%).

In a follow-up study of 1,249 patients who used 1.5% ruxolitinib cream on an as-needed basis, no serious infections, malignancies, major adverse cardiovascular events, or thromboembolic events were found.

The cream should not be used on more than 20% of the body surface area (about 20 handprints).

This medication has a black box warning of serious infection, heart attacks, blood clots, cancer and death. Learn more here.

EVIDENCE LEVEL

Ruxolitinib cream is a relatively new treatment and several studies have been published or presented on its use for eczema in patients aged 2 years or older. Two large trials of the drug were published in 2021.

AVAILABILITY

Approved in the US for individuals ages 12 years and older with mild to moderate eczema in 2021. Currently, there is an ongoing trial for children ages 2 to <12 years old.

For help paying for this treatment see: IncyteCARES patient support program.

EFFICACY

In two 8-week studies of 813 patients with moderate to severe eczema (aged 2 years and older), 55-59% of patients using 1% tapinarof cream once daily achieved a 75% improvement in their eczema severity (as measured by the EASI) and 52-55% of patients experienced significant itch reductions (4 points or greater measured by the Pruritus NRS score).

SAFETY

In two 8-week studies of 813 patients (aged 2 years and older), the most common side effects included: hair follicle inflammation (8%), headache (2-7%), and common cold (2-5%).

EVIDENCE LEVEL

Tapinarof is a relatively new treatment but several studies have been published on its use for eczema.

AVAILABILITY

It is approved in the US for individuals 2 years and older with moderate to severe eczema. Approved in some countries for psoriasis.

EFFICACY

In a study of 60 children with eczema (aged 2-10 years), patients using a topical calcineurin inhibitor, Tacrolimus/Protopic, saw a 56% reduction in the severity of their eczema compared to a 21% reduction in patients using a topical steroid, Hydrocortisone (as measured by the EASI).

In a review of published studies, one TCI (tacrolimus 0.1%) was better than low-potency corticosteroids and similar to moderate-to-potent corticosteroids on measures of symptom improvement.

SAFETY

In a clinical trial of 347 adult and child patients who used Tacrolimus (n=171), 9.9% experienced burning, 7% experienced itching, and 1.8% experienced redness. Of the patients using Pimecrolimus (n=176), 14.2% experienced burning, 10.2% experienced itching, and 3.4% experienced redness.

While there have been previous concerns of a link between calcineurin inhibitors and cancer, research has not supported that concern.

EVIDENCE LEVEL

TCI’s have been well studied. There are over 100 published research articles on TCI use for eczema.

AVAILABILITY

Tacrolimus has been approved in the US, Europe, Canada, and Japan.

Pimecrolimus has been approved in the US, Europe, Canada, Japan, and Australia.

EFFICACY

In a systematic review and meta-analysis of 12 randomized trials with 3462 patients, 71% of patients who used a variety of topical corticosteroids, or "TCS", had improvement in their eczema severity.

In one study, 66.7% of patients who used triamcinolone, a type of topical steroid, twice daily for 4 weeks had a 50% improvement in their eczema severity (as measured by the EASI).

In the same study, mean improvement for patients using TCS twice a day for 12 weeks was 86.8 %.

SAFETY

The likelihood of side effects depends on the strength of the topical corticosteroid.

Hydrocortisone is the weakest (safest) while betamethasone and clobetasol are among the strongest.

The same drug can come in many different forms including a cream (white in appearance), gels, and ointments (similar to vaseline). Ointments are the most potent of the various formulations. (See Potency Chart)

In one study, 25.6% of patients aged 13 or older experienced skin thinning, 13.3% experienced visible blood vessels on the cheeks, and 8.2% experienced acne.

EVIDENCE LEVEL

Topical Steroids have been well studied for use in eczema. Longer term studies are needed to fully understand side effects.

AVAILABILITY

Approved for use in children and adults for eczema in most countries.

POTENCY CHART

Super High Potency (Group 1)

• Betamethasone ointment 0.05%

• Clobetasol (all forms) 0.05%

High Potency (Group 2)

• Betamethasone cream 0.05%

• Clobetasol cream 0.025%

High Potency (Group 3)

• Desoximetasone cream 0.05%

• Mometasone ointment 0.1%

• Triamcinolone 0.5%

Medium Potency (Group 4)

• Mometasone cream 0.1%

• Triamcinolone 0.1%

Lower-mid potency (Group 5)

• Desonide ointment 0.05% cream

Low potency (Group 6)

• Desonide lotion

• Triamcinolone lotion 0.025%

Lowest potency (Group 7)

• Hydrocortisone

Citation

EFFICACY

The most common types of phototherapy used to treat eczema are narrowband ultraviolet A (NB-UVA) or ultraviolet B (NB-UVB) light.

A review of evidence from 2021 found that when compared to placebo (or no treatment), NB-UVB improves physician-rated signs and patient-reported symptoms after 12 weeks.

SAFETY

Short term side effects include temporary burning, dry skin, and itching.

In one clinical trial of 144 patients, 61% of patients experienced redness after phototherapy and 9% experienced burning.

Some patients may notice skin darkening in the areas that were treated.

This study found that UVB phototherapy does not appear to increase the risks of skin cancer in patients with eczema.

Long term side effects have not been well studied.

EVIDENCE LEVEL

UV phototherapy has been studied for use in eczema, but more research is needed on the safety and effectiveness of all aspects of phototherapy for eczema.

AVAILABILITY

Phototherapy is usually a second-line treatment option that is only available at specialist clinics or hospitals. It is usually recommended for children (generally five years or older) if their eczema is severe and not responding to creams and ointments. Phototherapy is available in most countries.