eczema is treated. The authors emphasized that newer 
therapies can improve symptom control while also sup-
porting longer-term disease management and quality 
of life.2
A Shift Away From Steroids
Topical corticosteroids have long served as the foundation 
of eczema treatment, but their limitations—particularly 
with long-term use—have led clinicians to seek safer and 
more sustainable options.
The review noted that nonsteroidal topical therapies 
have emerged as effective alternatives, particularly for 
reducing itch and improving disease control. In addition 
to offering the potential for longer-term management, 
the authors wrote, “These therapies can provide mean-
ingful improvements in both clinical signs and patient-
reported symptoms.”
The authors also suggested that nonsteroidal options 
may be especially appropriate in areas where corticoste-
roids are limited by safety concerns. In clinical practice, 
dermatologists also are seeing this shift.
“For 
decades, 
topical 
corticosteroids 
anchored 
our treatment approach largely by default, because 
our nonsteroidal options were limited,” explained 
Faranak Kamangar, MD, president of the San Francisco 
Dermatological Society and department chair of 
dermatology at Sutter Health in Palo Alto. “That has 
now changed, and we have a robust toolkit—ruxolitinib, 
tapinarof, roflumilast and others—that are effective for 
reducing itch and skin symptoms, support longer disease 
control with fewer relapses and carry favorable safety 
profiles without requiring blood monitoring.”
“These therapies are particularly well-suited for 
sensitive areas such as the face, skin folds, and genitalia,” 
she told the Compendium of Federal Medicine. “It’s time 
to rethink our prescribing paradigm and stop treating 
steroids as the default and everything else as second-tier.”
The first topical JAK inhibitor approved by the U.S. 
Food and Drug Administration (FDA) was ruxolitinib, 
marketed as Opzelura, in 2021. The FDA designated the 
product for “the short-term and non-continuous chronic 
treatment of mild to moderate atopic dermatitis (AD) in 
non-immunocompromised patients 12 years of age and 
older whose disease is not adequately controlled with 
topical prescription therapies, or when those therapies are 
not advisable.”
Of special interest to clinicians working within the 
Military Health System (MHS) which treats nearly 2 mil-
lion children under age 18 through its TRICARE program, 
the FDA late last year gave the OK for use of the topical 
treatment in children ages 2-11 with atopic dermatitis. 
Specifically, the 1.5% topical JAK inhibitor was 
approved for the short-term and noncontinuous 
chronic treatment of mild to moderate AD in non-
immunocompromised children 2 years of age and 
older whose disease is not well controlled with topi-
cal prescription therapies or when those therapies are 
not recommended. 
Tapinarof cream, 1%, is an aryl hydrocarbon receptor 
(AhR), while roflumilast and crisaborole are topical 
phosphodiesterase 4 (PDE4) inhibitors. Tacrolimus and 
pimecrolimus act by inhibiting calcineurin, thereby 
stopping immune system cells (T-lymphocytes) from 
attacking transplanted organs or causing inflammatory 
skin conditions. Delgocitinib 2% cream is an FDA-
approved JAK inhibitor for moderate-to-severe chronic 
hand eczema (CHE) in adults unresponsive to or 
unsuitable for topical corticosteroids. 
The review, led by researchers from the University of 
California, Los Angeles, reached unanimous consensus 
on seven statements regarding advanced topical nonste-
roidal therapies, including topical ruxolitinib, tapinarof, 
roflumilast, crisaborole, tacrolimus, pimecrolimus and 
delgocitinib. 
“These therapies were considered effective in 
reducing AD signs and symptoms, including pruritus, 
and appropriate as first-line agents for many patients,” 
according to the report. “Their use was associated with 
longer disease control, fewer relapses, and reduced 
cumulative topical corticosteroid exposure. The panel 
agreed that these therapies improve patient-reported 
outcomes, including quality of life and sleep, and can 
be safely incorporated into combination regimens with 
other topical or systemic treatments. They demonstrated 
favorable safety and tolerability profiles without the need 
for baseline or ongoing laboratory monitoring.”
The panel noted that, compared with topical 
corticosteroids, “nonsteroidal therapies were preferred 
for long-term management to avoid steroid-associated 
adverse effects, with simplified dosing and suitability for 
sensitive and high-impact sites supporting adherence.”
The review concluded, “Advanced topical nonsteroidal 
therapies represent an important evolution in AD 
management and are appropriate first-line options across 
disease severities, supporting sustained disease control and 
improved quality of life.”
Improving Daily Life
Beyond its visible symptoms, eczema can significantly 
disrupt daily life.
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