New approaches to topical therapy

Despite the rapid and proven efficacy of topical corticosteroids, side-effects can limit their clinical usefulness. Topically active macrolide immunosuppressants such as ascomycin and tacrolimus appear to provide comparable therapeutic potency without significant local or adverse effects. Data from ongoing studies will be crucial in determining the safety of these agents in the long term, and also their place within the current therapeutic armamentarium available for patients with atopic dermatitis. Enzyme inhibitors of PLA(2) and PDE 4 currently in the very early stages of clinical development also show potential promise as additional alternative strategies to topical treatment and may perhaps act as steroid sparing agents. Having been in the therapeutic doldrums for years, topical management of atopic dermatitis is likely to show great changes in the very near future.