Table 1.
Topical treatments in pediatric atopic dermatitis and psoriasis patients.
| Medication | Topical Moisturizer and Emollients | Wet Wraps | Corticosteroids | Narrow-Band UVB Phototherapy | Topical Calcineurin Inhibitors | Topical Vitamin D Analogue | Crisaborole |
|---|---|---|---|---|---|---|---|
| Use | AD Psoriasis |
AD Psoriasis |
AD Psoriasis |
AD Psoriasis |
AD Psoriasis |
Psoriasis | AD |
| Mechanism | Improve barrier function and reduce transdermal evaporation | Provide vehicle occlusion enhancing absorption | Anti-inflammatory and anti-proliferative effects | Decreases cell proliferation, immunosuppression, T cell apoptosis | Inhibits T-Lymphocyte activation and transcription of genes that code for IL-3,4,5, GM-CSF and TNF-a | Inhibit proliferation and stimulate differentiation of keratinocytes | PDE-4 inhibitor |
| Dosing Regimen | At least 2x daily after bathing and handwashing | PRN | Various strengths and formulations available | Initial dose 50 of minimal erythema dose, then gradual increase to maximum tolerated dose or 2000 to 5000 mJ/cm2 two to five times/week | Apply a thin layer 2x daily | Apply a thin layer 2x daily avoid face and eyes | 2% ointment 2x daily to affected areas |
| Contraindications | None | None | Local bacterial or fungal infections | Xeroderma pigmentosum, lupus erythematosus | Hypersensitivity to tacrolimus or pimecrolimus | Hypersensitivity to ingredients, hypercalcemia or vitamin D toxicity | Hypersensitivity to any ingredients |
| Adverse Effects | None | None | Common: striae, bruising, acne Severe: Risk of systemic absorption |
Common: erythema, xerosis, pruritus, blistering Severe: increased frequency of recurrent herpes simplex, photocarcinogenesis |
Burning or stinging at application site | Skin irritation | <1% contact urticaria >1%application site pain (burning or stinging) |
| Baseline Lab Monitoring | None | None | None | None | None | None | None |
| FDA-approved in pediatric populations | NA | NA | Patients >12 years of age | Patients > 6 years of age | Tacrolimus 0.03% for patients 2–15, pimecrolimus 1% for patients > 2 years of age | Not approved for pediatric patients | Patients 2 years of age and older |
Abbreviations: PRN = pro re nata (as needed); NA = not available; IL = interleukin; GM-CSF = granulocyte-macrophage colony stimulating factor; TNF-α = tumor necrosis factor alpha; PDE = phosphodiesterase; FDA = Food and Drug Administration.