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Higher-potency topical corticosteroids, JAK inhibitors, and tacrolimus 0.1% were deemed the most effective topical anti-inflammatory treatments for atopic dermatitis (AD) following a network meta-analysis published recently in the .

PDE-4 inhibitors ranked among the least-effective eczema treatments, along with milder topical corticosteroids and tapinarof 1%. Topical calcineurin inhibitors and crisaborole 2% carried the highest risk of application-site reactions; topical corticosteroids carried the lowest risk.

Review co-author Robert Boyle, MBChB, PhD, is a professor of pediatric allergy and an inflammation and immunology researcher with the National Heart and Lung Institute at Imperial College London in the United Kingdom. His exchange with the Reading Room has been edited for length and clarity.

What were the questions this analysis was designed to address, and the objectives it was designed to achieve?

Boyle: We wanted to work out which are the most effective and safest eczema treatments. We focused on anti-inflammatory creams such as steroid creams, because these are the main treatments used around the world for controlling eczema flares.

We aimed to pull together all available data that has ever been published. This allowed us to rank the effectiveness and safety of different treatments.

What were some of the key findings and/or conclusions the research team uncovered during this analysis?

Boyle: Our first finding was that research studies that test new anti-inflammatory creams for eczema are not being fully reported. This lack of transparency makes it challenging to work out which creams are most effective or safe.

Despite this important limitation, however, we were able to classify different treatments as more effective and less effective, and as more and less likely to cause certain types of side effects.

The finding that potent steroid creams are highly effective for short-term control of eczema symptoms is consistent with other studies. Others have not, however, highlighted the issue of transparency and industry influence in this field.

How would you summarize the review's findings around safety and adverse effects for these treatments? Are these consistent with previous analyses?

Boyle: Overall, we found steroid creams, which are the cheapest topical anti-inflammatory treatment, to be among the most effective treatments for controlling eczema symptoms. We also found they were less likely than newer treatments to sting or burn when first used.

However, when used for long periods -- between 6 months and 5 years -- there was a small (1 in 300) risk of skin thinning. The studies did not report how serious the skin thinning was or how often it got better once treatment stopped.

What are the bottom-line messages from your findings?

Boyle: Topical steroids remain the main treatment for eczema flares. Even with longer-term treatment, significant side effects appear to be rare.

Also, some newer and more expensive anti-inflammatory eczema creams are more likely to sting than steroid creams, and may be less effective.

What might or should the future hold in terms of new research into relevant areas and/or new topical anti-inflammatory treatment options for AD?

Boyle: We need more independent trials, more evaluation of long-term outcomes including safety, and more head-to-head active comparator trials in this field.

There is a lack of research on eczema cures or eczema prevention compared with these daily or twice daily treatments that need to be used for months, years, or decades.