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Expanding the Topical Therapeutic Landscape for Atopic Dermatitis: A Systematic Review
Joshua Burshtein1, Sara Nahon2, Diego Ruiz Dasilva3
1Dr. Burshtein is with the Department of Dermatology at the University of Illinois-Chicago, Chicago, Illinois.
Background:
Atopic dermatitis (AD) is a common chronic inflammatory disease. Despite its global prevalence, the current standard of care has remained unchanged for many years. Historically, first-line agents include topical corticosteroids (TCS) and topical calcineurin inhibitors (TCIs). However, these agents have significant limitations, including local and systemic adverse effects. In the last several years, novel topical therapeutic agents have been approved by the United States Food and Drug Administration (FDA) and more are being developed.
Objective:
The present review aims to summarize these topical therapeutic advances and report their efficacy and safety relative to the existing armamentarium.
Methods:
Three searches were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Agency for Healthcare Research and Quality Methods Guide for Effectiveness and Comparative Effectiveness Reviews guidelines. These included electronic searches of FDALabel (without date restriction) and PubMed and ClinicalTrials.gov (between April 8, 2020 and April 8, 2025).
Results:
A total of 52 nongeneric, prescription topical therapeutic agents are currently approved by the FDA for AD, the majority of which are TCS (n=11; 52.4%) and TCIs (n=4; 19.0%). There have been several agents with novel mechanisms of action (n=3; 7.6%) approved by the FDA in recent years, including Janus kinase (JAK) inhibitors, nonsteroidal aryl hydrocarbon receptor (AhR) modulators, and phosphodiesterase 4 (PDE4) inhibitors.
Conclusion:
In the last 5 years, important innovations in the therapeutic landscape of AD have emerged. Treatments include novel JAK inhibitors, AhR modulators, and PDE4 inhibitors. Adopting these therapies as part of clinical care can improve patients' therapeutic outcomes and quality of life.
