Topical use of caffeine with hydrocortisone in the treatment of atopic dermatitis

Abstract

In a double-blind study, topically applied caffeine 30%-hydrocortisone 0.5% in hydrophilic ointment was compared to betamethasone valerate 0.1% cream and to hydrocortisone 0.5% in hydrophilic ointment. Eighty-three patients were evaluated over a three-week period for pruritus, erythema, scaling, lichenification, excoriation, oozing, and global impression. The betamethasone and caffeine-hydrocortisone groups performed significantly better than the hydrocortisone group on three of the seven scales: lichenification, excoriation, and global impression. Also, the betamethasone group differed significantly from the hydrocortisone group on six of the seven scales, but did not differ significantly from the caffeine-hydrocortisone group on any scale. It is suggested that caffeine is effective because it elevates local levels of cyclic adenosine-3',5'-monophosphate by inhibiting phosphodiesterase.

The effects of treatment on itch in atopic dermatitis

“…Similarly, Kaplan and colleagues found that betamethasone valerate 0.1% cream (class 5) was superior to hydrocortisone hydrophilic ointment 0.5% (formulation unclear) in reducing pruritus after three weeks. Mean pruritus was significantly reduced from 3.6 to 1.7 (scale of 0–5) in the hydrocortisone-treated group and from 3.7 to 0.7 in the betamethasone valerate goup (29). …”

Topical use of systemic drugs in dermatology: A comprehensive review

“…In another study, topical caffeine was shown to have a similar efficacy as 0.1% betamethasone valerate for the treatment of atopic dermatitis. 20 When combined with 0.5% hydrocortisone, topical caffeine was more effective than 0.5% hydrocortisone alone. Its efficacy in the management of atopic dermatitis is presumably mediated through inhibiting cyclic nucleotide phosphodiesterase with subsequent increased skin levels of cyclic adenosine monophosphate (AMP).…”

Caffeine in the Treatment of Atopic Dermatitis and Psoriasis: A Review

“…Moreover, the caffeinehydrocortisone and the betamethasone groups did not differ statistically significantly on any scale. [47] The main side effect of the caffeine preparation was an immediate pruritic or burning sensation, which occurred in 4 out of an original 90 participants selected for the study. This may have been due to the "grittiness" of the caffeine blend, as described by the authors.…”

“…This may have been due to the "grittiness" of the caffeine blend, as described by the authors. [47] Corticosteroids, on the other hand, may cause side effects such as pigment changes, perioral dermatitis, delayed wound healing, and others, making the use of caffeine to enhance the effect of lower concentrations of corticosteroids an attractive option. [47,48] In another trial, Vali et al tested caffeine 10% (in a plastibase of liquid paraffin and polyethylene) on the plaque psoriasis of 39 patients, versus a placebo.…”