Atopic dermatitis: Other topical agents

Topical coal tar derivatives have been used for many years in the treatment of inflammatory skin diseases, particularly psoriasis. There are, however, very few trials of coal tar preparations and their efficacy in the treatment of AD.121 Munkvad122 investigated a preparation designed to be more cosmetically acceptable than traditional formulations and found it to be as effective as 1% hydrocortisone acetate cream on left/right paired comparison for mild to moderate disease. But given only a 4-week study and 5 of 30 patients reported itching and soreness, there are not adequate data to make a recommendation regarding the use of coal tar topical agents. A recent study of organotypic skin models from patients with AD and control subjects did find that coal tar activates the aryl hydrocarbon receptor signaling pathway, resulting in enhanced epidermal differentiation, increased levels of filaggrin, and inhibition of a major AD cytokine pathway (interleukin-4/signal transducer and activator of transcription (STAT)-6).123 

Topical phosphodiesterase inhibitors are another new class of anti-inflammatory treatments,124,125 but remain available only in clinical trials, also precluding any recommendations for or against their use at this time.

References

  1. Slutsky, J.B., Clark, R.A., Remedios, A.A., and Klein, P.A. An evidence-based review of the efficacy of coal tar preparations in the treatment of psoriasis and atopic dermatitis. J Drugs Dermatol. 2010; 9: 1258–1264
  2. Munkvad, M. A comparative trial of Clinitar versus hydrocortisone cream in the treatment of atopic eczema. Br J Dermatol. 1989; 121: 763–766
  3. van den Bogaard, E.H., Bergboer, J.G., Vonk-Bergers, M., van Vlijmen-Willems, I.M., Hato, S.V., van der Valk, P.G. et al. Coal tar induces AHR-dependent skin barrier repair in atopic dermatitis. J Clin Invest. 2013; 123: 917–927
  4. Griffiths, C.E., Van Leent, E.J., Gilbert, M., and Traulsen, J. Randomized comparison of the type 4 phosphodiesterase inhibitor cipamfylline cream, cream vehicle and hydrocortisone 17-butyrate cream for the treatment of atopic dermatitis. Br J Dermatol. 2002; 147: 299–307
  5. Hanifin, J.M., Chan, S.C., Cheng, J.B., Tofte, S.J., Henderson, W.R. Jr., Kirby, D.S. et al. Type 4 phosphodiesterase inhibitors have clinical and in vitro anti-inflammatory effects in atopic dermatitis. J Invest Dermatol. 1996; 107: 51–56

Navigate section 2 of the AD guideline: Topical therapy     

Citation note 

When referencing this guideline in a publication, please use the following citation: Eichenfield LF, Tom WL, Berger TG, Krol A, Paller AS, Schwarzenberger K, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014 Jul;71(1):116-32.

 


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