This article is more than 5 years old. Information may no longer be current.

Crisaborole ointment possible first-line agent in psoriasis for thin, sensitive skin

In a pilot study, crisaborole ointment 2% led to significant lesion improvement in intertriginous, anogenital and facial psoriasis and may serve as a first-line therapy in these sensitive skin regions.

“Treatment with this agent could allow for avoidance of the risks and side effects associated with topical steroids and calcineurin inhibitors,” Peter W. Hashim, MD, MHS, of the department of dermatology at the Icahn School of Medicine at Mount Sinai, New York, and colleagues wrote.

Crisaborole (Pfizer) is a novel, nonsteroidal, topical agent that was approved in 2016 for the treatment of mild to moderate atopic dermatitis, according to the researchers. It is a phosphodiesterase (PDE)-4 inhibitor that increases levels of intracellular cyclic adenosine monophosphate and decreases the production of pro-inflammatory cytokines.

The double-blind, randomized, vehicle-controlled study included 21 subjects with intertriginous, anogenital or facial psoriasis who were randomized 2:1 to receive treatment with either crisaborole ointment 2% twice daily or vehicle ointment twice daily. Starting on day 29, all subjects received open-label crisaborole ointment 2% twice daily until day 57.

Study subjects were 18 years or older, were diagnosed at least 6 months prior and had a target lesion of at least moderate severity on the Target Lesion Severity Scale (TLSS).

The percent change in lesion severity was measured using the TLSS between baseline and day 29 as the primary efficacy endpoint.

In the crisaborole group, at day 29, subjects demonstrated a 66% improvement in TLSS vs. 9% in the vehicle group (P = .0011).

Both treatment groups experienced improvement in the open-label period with crisaborole. At day 57, subjects in the crisaborole group had achieved 81% improvement in TLSS compared with baseline, whereas 71% reached clinical significance.

The researchers reported no adverse skin reactions at application sites.

“Topical PDE-4 inhibitors represent a new and promising therapeutic option for inflammatory dermatoses,” they wrote.

Study limitations included the small sample size and subjects from a single tertiary care center.

“For topical therapy of psoriasis on thin, sensitive or occluded skin regions, crisaborole ointment may serve as a valuable first-line agent,” Hashim and colleagues wrote. – by Abigail Sutton

Disclosures: Hashim reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. The study was supported by a Pfizer ASPIRE Dermatology Research Award.