What is Crisaborole: Uses, Dosage, Side Effects and More

Crisaborole is a topical medication that helps treat mild to moderate eczema (atopic dermatitis) by reducing inflammation and itching. This gentle, non-steroidal cream works differently than traditional steroid treatments, making it a valuable option for people who need long-term eczema management without some of the concerns that come with prolonged steroid use.

What is Crisaborole?

Crisaborole is a phosphodiesterase-4 (PDE-4) inhibitor that comes as a topical ointment. It's specifically designed to treat eczema by targeting the inflammatory process that causes the red, itchy, and irritated skin patches characteristic of this condition.

Unlike topical steroids, crisaborole doesn't suppress your immune system broadly. Instead, it works more selectively by blocking specific enzymes that contribute to inflammation in your skin. This targeted approach makes it particularly useful for sensitive areas like the face and neck, where long-term steroid use might cause thinning or other skin changes.

The medication was approved by the FDA in 2016 and has become an important treatment option for both children and adults with eczema. It's available only by prescription and is typically recommended when other treatments haven't provided adequate relief or when you need a non-steroidal option for ongoing management.

What is Crisaborole Used For?

Crisaborole is primarily used to treat mild to moderate atopic dermatitis, commonly known as eczema. This chronic skin condition causes patches of skin to become inflamed, itchy, red, and sometimes cracked or scaly.

Your doctor might recommend crisaborole if you experience typical eczema symptoms like persistent itching, red or brownish patches of skin, small raised bumps that may leak fluid when scratched, or thickened, cracked, or scaly skin. It's particularly helpful for treating eczema on sensitive areas of your body, including your face, eyelids, neck, and skin folds.

The medication is also valuable for long-term maintenance therapy. Because it doesn't carry the same risks as long-term steroid use, many doctors recommend it for people who need ongoing treatment to prevent eczema flare-ups. It can be used safely for extended periods without the concern of skin thinning or other steroid-related side effects.

How Does Crisaborole Work?

Crisaborole works by blocking an enzyme called phosphodiesterase-4 (PDE-4) in your skin cells. This enzyme normally breaks down a substance called cyclic adenosine monophosphate (cAMP), which helps control inflammation.

When PDE-4 is blocked, cAMP levels increase in your skin cells. Higher cAMP levels help reduce the production of inflammatory substances that cause the redness, swelling, and itching associated with eczema. Think of it as turning down the volume on your skin's inflammatory response rather than completely shutting it off.

This mechanism makes crisaborole a moderately strong anti-inflammatory medication. It's not as immediately powerful as high-potency topical steroids, but it provides steady, consistent relief without the potential for skin thinning or other steroid-related complications. The medication typically begins working within a few days to a week of regular use, with full benefits often seen after 2-4 weeks of consistent application.

How Should I Take Crisaborole?

Apply crisaborole exactly as your doctor prescribes, typically twice daily to the affected areas of skin. You can apply it with or without food, as it's a topical medication that doesn't interact with what you eat.

Start by washing your hands thoroughly before application. Clean the affected skin gently with mild soap and water, then pat it dry. Apply a thin layer of the ointment to the affected areas and gently rub it in until it disappears. The medication should be applied to your skin, not mucous membranes like inside your mouth or nose.

After applying crisaborole, wash your hands again unless you're treating your hands themselves. You don't need to cover the treated areas with bandages or dressings unless your doctor specifically recommends it. You can apply moisturizer over the medication if needed, but wait a few minutes for the crisaborole to absorb first.

Avoid getting the medication in your eyes, mouth, or inside your nose. If this happens accidentally, rinse the area thoroughly with water. You can bathe or shower normally while using crisaborole, but try to apply the medication to clean, dry skin for best absorption.

How Long Should I Take Crisaborole For?

The duration of crisaborole treatment varies depending on your individual response and the severity of your eczema. Most people begin to see improvement within the first week of use, with significant benefits typically appearing after 2-4 weeks of consistent application.

For acute flare-ups, you might use crisaborole for several weeks until your symptoms are well-controlled. Once your eczema improves, your doctor may recommend continuing the medication as maintenance therapy to prevent future flare-ups. This is one of the advantages of crisaborole - it can be used safely for extended periods without the concerns associated with long-term steroid use.

Some people use crisaborole for months or even years as part of their ongoing eczema management plan. Your doctor will monitor your progress and may adjust your treatment plan based on how well your skin responds and whether you experience any side effects. Don't stop using the medication abruptly without consulting your healthcare provider, as this might lead to a return of your symptoms.

What Are the Side Effects of Crisaborole?

Most people tolerate crisaborole well, but like all medications, it can cause side effects. The good news is that serious side effects are uncommon, and most reactions are mild and temporary.

Common side effects that affect up to 10% of people include:

• Burning or stinging sensation at the application site (usually mild and temporary)
• Skin irritation or redness where you apply the medication
• Itching at the application site (which may seem counterintuitive since the medication treats itching)
• Skin pain or tenderness
• Allergic contact dermatitis (skin reaction to the medication itself)

These common reactions typically occur when you first start using the medication and often improve as your skin adjusts to the treatment. The burning or stinging sensation is usually most noticeable during the first few applications and tends to decrease with continued use.

Less common but more concerning side effects include:

• Severe allergic reactions (rash, hives, difficulty breathing, swelling of face, lips, or throat)
• Signs of skin infection (increased redness, warmth, pus, or fever)
• Worsening of your eczema symptoms
• Unusual skin changes or discoloration

If you experience any severe reactions or if mild side effects don't improve after a week of use, contact your healthcare provider. They can help determine whether you should continue the medication or try a different treatment approach.

Who Should Not Take Crisaborole?

Crisaborole is not suitable for everyone, and certain people should avoid using this medication. Your doctor will review your medical history and current health status before prescribing it.

You should not use crisaborole if you're allergic to it or any of its ingredients. Signs of an allergic reaction include severe rash, hives, difficulty breathing, or swelling of your face, lips, tongue, or throat. If you've had allergic reactions to similar topical medications in the past, make sure to tell your doctor.

People with certain skin conditions should use crisaborole with caution:

• Active skin infections (bacterial, viral, or fungal) at the treatment site
• Open wounds or severely damaged skin
• Skin conditions other than eczema that might be worsened by the medication
• History of severe allergic reactions to topical medications

Special considerations apply to pregnant and breastfeeding women. While studies haven't shown harmful effects to unborn babies, crisaborole should only be used during pregnancy if the potential benefits outweigh the risks. If you're breastfeeding, avoid applying the medication to areas where your baby might come into contact with it, such as the chest or nipple area.

Children under 2 years old should not use crisaborole unless specifically recommended by a pediatric dermatologist. The safety and effectiveness in very young children haven't been fully established.

Crisaborole Brand Names

Crisaborole is available under the brand name Eucrisa in the United States. This is currently the primary brand name under which the medication is marketed and prescribed.

Eucrisa is manufactured by Pfizer and comes as a 2% topical ointment. The medication is available in tubes of different sizes, typically 60 grams or 100 grams, depending on your prescription and treatment needs.

Currently, there are no generic versions of crisaborole available in the United States. This means Eucrisa is the only brand option, which can make the medication more expensive than generic alternatives. However, many insurance plans do cover crisaborole, and the manufacturer offers patient assistance programs to help reduce costs for eligible individuals.

Crisaborole Alternatives

If crisaborole isn't suitable for you or doesn't provide adequate relief, several alternative treatments are available for eczema management. Your doctor can help you explore these options based on your specific needs and medical history.

Topical corticosteroids remain the most commonly prescribed alternatives. These include mild options like hydrocortisone for sensitive areas, medium-strength steroids like triamcinolone for body areas, and stronger options like clobetasol for severe flare-ups. While effective, these medications require careful monitoring for long-term use to prevent side effects like skin thinning.

Other non-steroidal alternatives include:

• Topical calcineurin inhibitors (tacrolimus, pimecrolimus) - particularly useful for face and neck treatment
• Topical JAK inhibitors like ruxolitinib - a newer option for mild to moderate eczema
• Barrier repair creams and prescription moisturizers
• Antihistamines for itching relief

For severe eczema that doesn't respond to topical treatments, systemic options might be considered. These include oral medications like dupilumab injections, methotrexate, or cyclosporine, though these are typically reserved for more severe cases due to their potential for more significant side effects.

Is Crisaborole Better Than Tacrolimus?

Both crisaborole and tacrolimus are effective non-steroidal treatments for eczema, but they work differently and have distinct advantages. The choice between them depends on your specific situation, skin sensitivity, and treatment goals.

Crisaborole tends to be gentler and causes less burning or stinging upon application compared to tacrolimus. This makes it a better choice for people with very sensitive skin or those who couldn't tolerate tacrolimus due to initial irritation. Crisaborole also doesn't carry the FDA's black box warning that tacrolimus has regarding potential cancer risk with long-term use.

However, tacrolimus is generally considered more potent and may be more effective for moderate to severe eczema. It's been available longer and has more extensive research supporting its use. Tacrolimus also tends to work faster than crisaborole, with some people seeing improvement within days rather than weeks.

For facial eczema, both medications are good options since they don't cause skin thinning like steroids. Your doctor might start with crisaborole if you have sensitive skin or concerns about tolerability, then consider tacrolimus if you need stronger anti-inflammatory effects. Some people even use both medications at different times or for different body areas as part of their treatment plan.