CLINICAL QUESTION

Which topical anti-inflammatory drugs are most effective for the treatment of eczema (atopic dermatitis)?

EVIDENCE-BASED ANSWER

Low- to moderate-confidence evidence shows that select topical anti-inflammatory drugs are the most effective treatment for eczema. These potent and very potent drugs include corticosteroids (eg, clobetasol), calcineurin inhibitors (eg, tacrolimus 0.1%), and Janus kinase inhibitors (eg, ruxolitinib 1.5% [Opzelura]). Alternatively, phosphodiesterase 4 (PDE4) inhibitors (eg, crisaborole 2%) are among the least effective. Adverse effects (eg, burning, stinging) are more likely with topical calcineurin inhibitors and PDE4 inhibitors and less likely with topical corticosteroids.¹ (Strength of Recommendation: A, consistent, good-quality, patient-oriented evidence.)

PRACTICE POINTERS

Eczema, also known as atopic dermatitis, is a chronic, pruritic, inflammatory skin condition. Patients often have concomitant allergic rhinitis and asthma.² Although it affects up to 25% of children, prevalence decreases with age; only 7.3% of adults reported eczema symptoms in the 2021 National Health Interview Survey.^2,3 The authors of this Cochrane review investigated the most effective and safest topical anti-inflammatory drugs for eczema.¹