United States Air Force Academy, Colorado Springs, CO.
Ohio University Heritage College of Osteopathic Medicine, Dublin, OH.
Skinmed. 2023 Aug 28;21(3):177-181. eCollection 2023.
Since its introduction in 1952, topical glucocorticosteroids remain the initial and long-term treatment option for various forms of inflammatory dermatitis. A number of non-steroidal topicals for treating inflammatory dermatoses have been developed in the recent decades (such as topical calcineurin inhibitors, vitamin D analogues, and phophodiesterase-4 inhibitors), but none had the combination of broad therapeutic range, relatively rapid onset of action, high tolerability, and wide-spread clinical success; this allowed topical glucocorticosteroids to remain the mainstay of therapy. This situation has shifted dramatically, with three non-steroidal new molecular entities, each with completely different mechanisms of action, receiving approval of the Food and Drug Administration (FDA) in the past year. Topical ruxolitinib, a Janus kinase (JAK) inhibitor, was approved by the FDA in September 2021 for atopic dermatitis, and was the subject of the first report in this review series. Subsequently, topical tapinarof, an aryl hydrocarbon receptor modulating agent, was approved by the FDA in May 2022 for treating plaque psoriasis, and is the focus of this present report. Finally and the most recently, topical roflumilast, a highly potent phosphodiesterase-4 inhibitor, received FDA approval in July 2022 for treating plaque psoriasis, and is reviewed in the third and final report in this series. In addition to their unique mechanisms of action and spectra of activity, each of these agents has unique clinical characteristics, including degree of efficacy, rapidity of onset of efficacy, potential remittive effects, and safety and tolerability profiles. In short, in this three-part series, we reviewed and summarized the data surrounding each agent, providing a comprehensive overview which would allow dermatologists to confidently and appropriately integrate them into treatment paradigms.
自 1952 年引入以来，局部糖皮质激素仍然是各种形式炎症性皮炎的初始和长期治疗选择。在最近几十年中，已经开发出许多用于治疗炎症性皮肤病的非甾体局部制剂（例如局部钙调神经磷酸酶抑制剂、维生素 D 类似物和磷酸二酯酶-4 抑制剂），但没有一种具有广泛的治疗范围、相对较快的作用开始、高耐受性和广泛的临床成功；这使得局部糖皮质激素仍然是治疗的主要方法。这种情况发生了巨大变化，过去一年中，有三种非甾体新型分子实体，每种都具有完全不同的作用机制，获得了美国食品和药物管理局 (FDA) 的批准。局部罗氟司特，一种 Janus 激酶 (JAK) 抑制剂，于 2021 年 9 月获得 FDA 批准用于治疗特应性皮炎，是本综述系列的第一份报告的主题。随后，局部他泊那非，一种芳烃受体调节剂，于 2022 年 5 月获得 FDA 批准用于治疗斑块状银屑病，是本报告的重点。最后，也是最近，局部罗氟司特，一种高效磷酸二酯酶-4 抑制剂，于 2022 年 7 月获得 FDA 批准用于治疗斑块状银屑病，在本系列的第三和最后一份报告中进行了综述。除了它们独特的作用机制和作用谱外，每种药物都具有独特的临床特征，包括疗效程度、疗效开始的速度、潜在的缓解效果以及安全性和耐受性特征。简而言之，在这三篇综述中，我们回顾和总结了每种药物的相关数据，提供了全面的概述，使皮肤科医生能够有信心和适当地将它们整合到治疗方案中。
