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Traditional Therapeutic Options

Topical Treatments for Mild Disease

Corticosteroids
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  • TCS usually the first line of treatment to reduce local inflammation
  • Can cause skin atrophy and thinning if used inappropriately (long-term use of high potency)
  • No consensus regarding optimal dosing or frequency, but early, aggressive TCS management followed by proactive therapy is now preferred by many
Calcineurin Inhibitors
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  • TCIs: tacrolimus and pimecrolimus
  • Nonsteroidal
  • Approved in 2000-2001
  • Inhibit calcineurin-dependent T-cell activation
  • No risk of skin atrophy
  • Use may be impeded by black box warning about increased risk for malignancy, despite lack of evidence to date
PDE4 Inhibitor
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  • Crisaborole
  • Nonsteroidal
  • FDA approved in 2016, first new treatment approved for AD in >15 years
  • Increases cAMP levels, leading to reduced cytokine expression
  • No data yet on long-term use

cAMP, cyclic adenosine monophosphate; FDA, Food and Drug Administration; PDE4, phosphodiesterase 4.