New and Upcoming Topical Treatments for Atopic Dermatitis: A Review of the Literature

Abstract

Atopic dermatitis (AD) is a chronic inflammatory dermatosis with periods of exacerbation and remissions. AD is characterized by intense, persistent pruritus and heterogeneity in clinical symptomatology and severity. Therapeutic goals include the amelioration of cutaneous eruptions, diminishing relapses and eventually the disease burden. To date, topical corticosteroids (TCS) and calcineurin inhibitors (TCI) have yet been deemed the mainstay of topical treatments in AD management. Nevertheless, despite their indisputable efficiency, TCS and TCI are not indicated for continuous long-term use given their safety profile. While research in AD has concentrated predominantly on systemic therapies, more than 30 novel topical compounds are under development. The existing data appear encouraging, with some regimens that are already FDA-approved (ruxolitinib was the most recent in September 2021) and several pharmaceutical pipeline products for mild-to-moderate AD that are in an advanced stage of development, such as tapinarof, difamilast and roflumilast. Larger, long-term studies are still required to evaluate the efficacy and safety of these novel compounds in the long run and weigh their advantages over present treatments. In this review, we aim to provide an overview of the latest knowledge about AD topical treatments, echoing upcoming research trends.

SNG100, a novel topical treatment for moderate atopic dermatitis, in patients aged 6 years or older: A randomised, double‐blind, active‐controlled trial

“…2,11,18,19 Topical treatments include TCS, calcineurin, phosphodiesterase 4 and Janus kinase inhibitors, and additional topical non-steroidal formulations are currently under development. [20][21][22] TCS, given their significant antiinflammatory effects, still serve as first line topical treatment in most cases of AD; however, although effective, these medications can lead to adverse effects following prolonged and inadequate use, including skin atrophy, telangiectasias and striae. 23,24 In addition, given the chronic nature of AD, many patients require prolonged and repetitive use of TCS, which further expose them to potential side effects due to systemic absorption, especially with the use of mid-to-high potency formulations.…”

“…The current therapeutic options for AD range from topical treatments for mild‐to‐moderate disease, to phototherapy, systemic and biologic agents for moderate‐to‐severe cases 2,11,18,19 . Topical treatments include TCS, calcineurin, phosphodiesterase 4 and Janus kinase inhibitors, and additional topical non‐steroidal formulations are currently under development 20–22 . TCS, given their significant anti‐inflammatory effects, still serve as first line topical treatment in most cases of AD; however, although effective, these medications can lead to adverse effects following prolonged and inadequate use, including skin atrophy, telangiectasias and striae 23,24 .…”

Bacterial Metabolites: A Link between Gut Microbiota and Dermatological Diseases

“…Tapinarof has passed phase 3 of a clinical trial in psoriasis, and it has gained FDA approval for plaque psoriasis treatment [ 94 , 95 ]. Tapinarof is also undergoing several phase 3 clinical trials in adults and children with atopic dermatitis [ 95 , 96 ]. The promising effect of activation of the AhR suggests that tryptophan metabolites could exert similar therapeutic effects and could also be a useful tool in the management of dermatological diseases.…”

Role of antioxidants in itch treatment: lessons learned from pain management

“…To date, there are a variety of anti-pruritic agents available, each targeting different aspects of the itch pathway. However, many of these agents have associated side effects and limited efficacy, and therefore are not recommended for chronic pruritus [52][53][54] . A recent survey of 1500 AD patients using topical corticosteroids showed that an overwhelming majority (91.5%) of patients had a desire for an alternative treatment option [55] .…”