The Case for Crisaborole

Abstract

To begin, topical corticosteroids (TCS) have been the standard first-line treatment medication for atopic dermatitis (AD) since the Federal Drug Administration (FDA) approved them in 1955 (Siegfried et al., 2016). Given that evidence-based practice (EBP) usually changes every few years for many other issues, that is a long period of time. This long-standing standard unfortunately leads many clinicians to the classic “we have always done it this way” conclusion. However, with scientific advancement, there are many more treatments available for AD today. One that is particularly promising is crisaborole, which is currently available under the brand name Eucrisa.

This medication is a PDE4 inhibitor, meaning that it binds to the PDE4 enzyme and inhibiting its activity. By this inhibition, crisaborole suppresses cytokine production and therefore the symptoms of AD (Papier et al., 2018). It is FDA approved for adults and children greater than three months old for the treatment of mild-to-moderate AD (Kondratuk et al., 2023). Clinical trials show that it not only improves lesions, but associated symptoms such as pruritis. Another important component is crisaborole’s unique advantage over TCS to be used on thin and sensitive skin areas such as the face, genitalia, and skin folds (Papier et al., 2018).

In continuation, crisaborole has many advantages over TCS. It is long known that TCS can cause unwanted side effects for patients, such as striae and skin atrophy (Papier et al., 2018; Butala & Paller, 2022. These effects become more likely with long term use (Eichenfield et al., 2017). These negative side effects put AD patients in a difficult position to either adhere to medication long-term and possibly suffer from premature skin-thinning, or deviate from treatment and risk worsening AD. This conundrum is often what is cited when patients report noncompliance (Papier et al., 2018; Lundin et al., 2021). In contrast, crisaborole is not associated with cutaneous side effects. The most common side effect is a burning sensation at the site of application (Eichenfield et al., 2017)

For these reasons, this proposed project suggests an EBP change regarding initial treatment of AD. Based on key factors, a clinician can predict with reasonable certainty whether a child or adolescent will continue to have AD into their adult life. It is the responsibility of the clinician to provide an individualized plan of care for these patients, which includes a long-term plan for successful treatment with the least harm, or potential harm, to those patients.

Date of publication

Spring 4-20-2024

Document Type

MSN Capstone Project

Language

english

Persistent identifier

http://hdl.handle.net/10950/4655

Degree

Masters in Nursing

Previous Versions

Apr 20 2024

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