Nonsteroid-based topical treatments
Nonsteroid–based topical treatments include pimecrolimus, crisaborole and tar preparations. Topical corticosteroids are the more effective treatment option; however, nonsteroid–based topical treatments can be considered in patients who are unable to tolerate topical corticosteroids, or in patients with a history of certain conditions that can worsen with topical corticosteroid use (eg rosacea, periorificial dermatitis).
Pimecrolimus 1% cream is a nonsteroid topical immunosuppressant with equivalent strength to mild topical corticosteroids. It is not adequate for acute, severe flares of dermatitis because it has low potency. It can be useful on sensitive areas (eg face, eyelids, axillae, groin) as maintenance therapy or preventative therapy at the onset of a flare. Consider:
pimecrolimus 1% (adult, or child older than 3 months) cream topically, once or twice daily. pimecrolimus pimecrolimus pimecrolimus
Concerns about potential long-term carcinogenic effects of pimecrolimus, based on its mechanism of action, have not been substantiated.
Crisaborole is a topical phosphodiesterase-4 inhibitor. It can be considered as an alternative to topical corticosteroids for milder dermatitis, and dermatitis in sensitive areas (eg face, flexures, groin). It can be expensive, and can cause irritation or stinging (particularly at the start of treatment). Consider:
crisaborole 2% (adult, or child 2 years or older) ointment topically, twice daily for up to 4 weeks. crisaborole crisaborole crisaborole
Tar preparations can be used with other topical therapies, and are especially helpful in dry or lichenified chronic dermatitis (eg hands, feet, knees). Consider:
LPC 3 to 6%+salicylic acid 2 to 6% in aqueous cream or simple ointment topically, once daily at night1. coal tar + salicylic acid coal tar+salicylic acid coal tar+salicylic acid