PDE4 Inhibitors for Atopic Dermatitis

Reviewed by: HU Medical Review Board | Reviewed June 2022 | Last updated: August 2022

You may have heard about some of the medications that are available to treat atopic dermatitis, but you may be wondering what makes them all different? This article will explain topical phosphodiesterase-4 (PDE4) inhibitors, how they work, and how patients respond to them.

What are PDE4 Inhibitors?

PDE4 inhibitors are medications that are targeted to treat diseases by changing cell signals in your immune system.1 PDE4 inhibitors work to block cellular pathways in your immune system that can lead to disease flares. When used for atopic dermatitis, these agents target cells in your body that cause inflammatory reactions by reducing specific proteins in your system called cytokines.1

How do PDE4 inhibitors work?

The currently approved PDE4 inhibitor works by blocking an enzyme in your body known as phosphodiesterase-4 (or PDE4).1 This changes your body chemistry and increases a cellular signal chemical known as cyclic adenosine monophosphate (cAMP). The increase of cAMP in your body then suppresses the release of proteins called cytokines that cause inflammation which can lead to atopic dermatitis.2

What is Eucrisa?

Currently, there is only one approved PDE4 available in the United States, Eucrisa (crisaborole). This medication comes in an ointment form and is approved for those with mild to moderate atopic dermatitis who are 3 months of age and older.4 This medication is applied twice a day during active flares of atopic dermatitis.2

As of October 2018, there are at least four other topical PDE4 inhibitors currently in active drug trials, and at least one oral PDE4 inhibitor being studied, though there are no expected release dates for these medications yet 1

How effective are PDE4 inhibitors?

Patients tend to have an excellent response to the approved PDE4 inhibitor. In a placebo-controlled trial, significantly more patients achieved clear to almost-clear skin using Eucrisa, than the patients on placebo.1,2 Patients also noticed that their skin became less itchy soon after starting Eucrisa, continued to experience relief from their itchiness while on the medication.1

What are possible side effects of PDE4 inhibitors?

Most patients have minimal side effects from PDE4 inhibitors.1,2 The most common side effects are pain and irritation where the medication is applied and sensitivity to the main ingredient in Eucrisa.

These are not all the possible side effects of Eucrisa. Patients should talk to their doctor about what to expect with treatment with Eucrisa.

Most patients apply the medication for four weeks, but the safety of Eucrisa has been evaluated up to 48-weeks, and side effects were still minimal. The medication was safe for more lengthy use.1 You should not use Eucrisa for extended periods of time without talking to your health care team first to make sure this is the right treatment for you.

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