Eczema (atopic dermatitis) can feel like a moving target for people who live with it. They get control over one flare, only to have eczema redden and irritate another patch of skin. For some patients, changing their bathing and beauty habits along with a thick moisturizer and topical corticosteroid ointments are enough.
“Steroids are the mainstay of treating atopic dermatitis. They’ve been around for decades. They are generally inexpensive, and for the vast majority of patients, that’s how we start treatment,” explains dermatologist Amy Paller, MD, director of the Northwestern University Skin Disease Research Center in Chicago. American Academy of Dermatology (AAD) guidelines recommend using emollient moisturizers, lifestyle changes to avoid triggers, and corticosteroids at first.
However, some people with eczema find those first steps offer little relief. For these people, new eczema treatments offer renewed hope.
When Corticosteroids Aren’t Enough
Jennifer Merrill, a resident of western Maine, is among those for whom eczema remains a frustrating puzzle. She’s had eczema since childhood. The 40-year-old managed to reduce the eczema on her scalp by washing her hair less frequently and abstaining from hairspray – only to find that eczema moved to the skin around her lips, eyes, wrist and stomach. A dermatologist prescribed a number of different creams, including topical corticosteroids.
“The steroids started to work in the beginning, but quickly things went from bad to worse,” she recalls.
Dr. Paller acknowledges that corticosteroids aren’t good options for everyone.
“Sometimes we have patients who can’t just intermittently put on steroids, clear their skin up, and use moisturizers. They are more chronic,” she says.
A different dermatologist put Merrill on antibiotics and a nonsteroid prescription medication, Elidel (pimecrolimus).
“Things calmed down a bit, but I would get random flares. After about six months on antibiotics I went back, at which time she did a biopsy and the results were eczema,” she says. At that point, Merrill’s dermatologist gave her samples of a medication approved for use on eczema in 2016: Eucrisa (crisaborole).
“It has helped somewhat. Pretty much cleared up the patches on my wrist, has helped but not completely cleared my face, and has done nothing for my stomach. The area I need to use it the most now is around my lips. I’ve used it on my wrists and belly and felt no side effects, but when applied around my lips it burns and itches like crazy! After a few minutes it will go away, but those first few are torture,” she says.
People like Merrill find their eczema requires a menu of strategies, including the relatively new topical Eucrisa (crisaborole).
Eucrisa was approved by the FDA in 2016 for use on eczema in people over the age of 2. A thin layer is applied to the affected areas twice daily.
Eucrisa has been shown to improve eczema symptoms safely, according to a review of the research on the ointment published in the December 2017 issue of the American Journal of Clinical Dermatology. According to the review, a small number of people using Eucrisa experience some pain at the site.
“Topical steroids, while effective, have many side effects, especially when used long term,” says dermatologist Emma Guttman, MD, PhD, vice chair of the department of dermatology at the Icahn School of Medicine at Mount Sinai in New York City. Side effects of corticosteroids include skin irritations and thinning of the skin.
“Many patients prefer to use a nonsteroid cream. Other nonsteroid creams such as Protopic (tacrolimus) and Elidel (pimecrolimus) currently have a black-box warning.”
The FDA requires Protopic and Elidel to carry a black-box warning letting consumers know there might be an increased risk of cancer associated with their use. Eucrisa does not have a black-box warning.
The Benefits of Eucrisa
“Eucrisa is indicated for mild to moderate eczema,” explains dermatologist Holly Gunn, MD, assistant professor in the department of dermatology at the University of Alabama School of Medicine in Birmingham. It is essentially an anti-inflammatory that targets a specific enzyme in the eczema which is causing inflammation. “Some patients love it and others say it didn’t work.”
Gunn says that she particularly likes Eucrisa for delicate skin, such as the skin on the face or close to the eyes, which might be further aggravated by steroid creams. Paller agrees that Eucrisa is promising for areas of delicate skin, and adds that the ointment seems to be effective for hand and foot eczema as well.
But, they say, each person’s skin will respond differently to treatment, so what works for one person might not work for the next. “We put Eucrisa, Elidel and Protopic in the same category,” she says, listing the other nonsteroidal options for eczema treatment.
The Drawbacks of Eucrisa
People who use Eucrisa may find that they feel a burning or stinging at the site, says Paller. Some people can continue to use the ointment and find the unpleasant sensations go away – while others might have to switch to another option, she says. There’s currently no standard recommendation on how to reduce the burning sensations. In some situations, using a corticosteroid ointment to reduce the inflammation and then using another ointment, such as Eucrisa, might help.
The biggest drawback to Eucrisa is its cost. However, says Gunn, it’s possible that you can use Eucrisa sparingly, either to give yourself a break from topical steroids or only on specific parts of your body.
“Typically, insurance companies like us to try less-expensive treatments first,” points out Gunn. So you might have to try other topical treatments before you can try Eucrisa. A 60-gram tube of Eucrisa runs approximately $600, while topical corticosteroids cost half that for a brand-name product, and a quarter as much for a generic. Check with your insurance provider to find out what your copays could be.
Overall, atopic dermatitis is estimated to cost the country $5 billion dollars annually. This annual cost includes the cost of treatment and hospitalization, as well as the cost of lost work and productivity, according to an article published in Advances in Experimental Medicine and Biology in 2017. The most cost-effective strategy for eczema management is the preventative use of moisturizer, according to the February 2017 issue of JAMA Pediatrics.
Paller points out that the arrival of newer eczema treatments such as Eucrisa, Elidel and Protopic is just the tip of the iceberg – she expects researchers in future years to develop more treatments based on increasingly nuanced understanding of how eczema works.