The Impact of Topical PDE-4 Inhibitors in Atopic Dermatitis, Seborrheic Dermatitis, and Psoriasis

During his session, “More Than Surface Level: The Role of Topical PDE-4 Inhibitors in the Treatment of Atopic Dermatitis, Seborrheic Dermatitis, and Psoriasis,” at Spring Dermatology Week 2024, Dr Joseph Merola illuminated the potential of topical phosphodiesterase-4 (PDE-4) inhibitors in the management of atopic dermatitis (AD), seborrheic dermatitis (SD), and psoriasis (PsO).

Dr Joseph F. Merola, MD MMSc, is chair of the department of dermatology and professor of dermatology, medicine, and rheumatology at the University of Texas Southwestern Medical Center in Dallas, TX. His session aimed to address the barriers to care and challenges in managing AD, SD, and PsO while exploring the role of PDE-4 inhibition in the pathogenesis of inflammatory skin diseases and its implications for treatment. Dr Merola provided insights into current and emerging topical PDE-4 inhibitors, reviewed their efficacy in treating intertriginous areas and pediatric populations, and outlined treatment strategies that consider patient goals and nonsteroidal topical agents.

Dr Merola highlighted the prevalent unmet needs in patients undergoing long-term conventional topical therapies, such as topical steroids, citing factors like negative side effects, inconvenient treatment regimens, and complex application instructions based on potency and location.

Through compelling case scenarios, like that of a 54-year-old woman with PsO and psoriatic arthritis, Dr Merola illustrated the mechanism of PDE-4 inhibition and its efficacy in achieving significant improvements in disease severity. Notable examples included roflumilast 0.3% cream, which demonstrated impressive efficacy in achieving clear or almost clear status and itch relief in patients with PsO and SD.

In the realm of AD management, Dr Merola discussed the epidemiology, comorbidities, and nonpharmacologic and topical management strategies. He emphasized the efficacy and safety of topical agents like crisaborole and roflumilast, as well as the promising results of the Janus kinase inhibitor ruxolitinib in AD treatment, including pediatric populations.

For SD, Dr Merola underscored the need for efficacious and safe long-term treatment options, presenting roflumilast as a novel therapeutic avenue supported by recent clinical trials.

Dr Merola concluded by addressing the critical issue of medication adherence in dermatologic care, proposing simplified regimens, patient education, follow-up visits, and positive patient-physician relationships as strategies to improve adherence.

In summary, Dr Joseph F. Merola's session provided valuable insights into the evolving landscape of dermatologic care, emphasizing the role of topical PDE-4 inhibitors as steroid-sparing agents and heralding new possibilities for improved patient outcomes in AD, SD, and PsO.

For more meeting coverage, visit the Spring Dermatology Week 2024 newsroom.

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Reference
Merola JF. More than surface level: the role of topical PDE-4 inhibitors in the treatment of atopic dermatitis, seborrheic dermatitis, and psoriasis. Presented at: Dermatology Week; May 8–11, 2024; Virtual.