Roflumilast and Tapinarof are 2 emerging topical therapies that have completed or have ongoing phase 3 clinical trials, with the possibility of approval in 2022.
Roflumilast is a more potent PDE4 inhibitor than crisaborloe (Eucrisa) with fewer local reactions.
Tapinarof, the first therapeutic arylhydocarbon modulating agent for which the only associated local effect is noninfectious folliculitis/follicular plugging with perifolliclular inflammation.
The last few years have brought on many new therapies for atopic dermatitis/eczema. For many year, the only treatment available was topical steroid medications. Which many patients avoided because of side effects. Elidel and Protopic were 2 medications that emerged after many years, but their efficacy was limited.
The last few years have seen 2 new topical therapies, Eucrisa and Opzeluara.
Two need injectable medications have also come out very recently and they are both used to treat moderate to severe eczema.
Most recently a new class of oral medications have come out called the JAK inhibitors, there are currently 2 available in this category.
Topical Roflumilast, is a PDE4 inhibitor, it increases cyclic AMP and inhibits proinflammatory cytokine release. It is a 0.15% cream for mild to moderate atopic dermatitis in trials. It is a nonsteroidal agent, it improves itch and inflammation. It is safe and effective for delicate areas (eg face), given it does not cause atrophy. There is no known ocular toxicity. Side effects are local irritation (and stinging/burning) are uncommon. Adverse effects to suggest systemic absorption of PDE4 inhibitor (nausea and diarrhea) are rare, (<1%). It is currently being studied for ages 2 and up.
Topical Tapinarof, is a therapeutic aryl hydrocarbon modulating agent. It agonizes keratinocyte aryl hydrocarbon receptor and also inhibits artemin and its stimulation of TRPV1 receptors on neurons. It is a 1% cream for moderate to severe atopic dermatitis in adults. It is non-steroidal and reports show an improvement in inflammation and itch. Only known adverse event is local folliculitis. Its being studied for 2 and up as well.
In conclusion, the treatment of eczema should start with topical steroids combined with nonsteroidal topical agents. These medications start the foundation for treatment. Then it is tailored on an individual basis while trying to avoid triggers and managing comorbid diagnoses. Systemic agents are next in line, but with the emerging availability of more targeted treatment such as roflumilast and tapinarof, systemic therapy may not be needed as much to achieve long term control and improve quality of life.