Skin & hair

Crisaborole, the Nonsteroidal Middle Step

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Not every eczema treatment step between moisturizer and a biologic injection has to involve a steroid. Crisaborole, sold as Eucrisa, is a prescription ointment that works through a different mechanism entirely, and it's become a common choice for eczema on the face and other areas where long-term steroid use raises more concern. Here's how it actually works, where it fits on the treatment ladder, and what to expect from it realistically.

Last updated: July 2026

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What Crisaborole Actually Is

Crisaborole, marketed as Eucrisa, is a topical prescription medication for mild-to-moderate atopic dermatitis that isn't a steroid and isn't a calcineurin inhibitor — it's a topical phosphodiesterase-4 (PDE4) inhibitor, a different drug class that works by blocking an enzyme involved in producing the inflammatory signals that drive eczema's redness, itching, and skin-barrier disruption. It's applied as an ointment, typically twice daily, to affected skin. Because it doesn't work through the same steroid receptor pathway that topical corticosteroids use, it doesn't carry the same risk of skin thinning with prolonged or repeated use, which is the main reason it gets chosen over a steroid in certain situations rather than because it clears eczema faster or more completely. Because it's non-sedating and doesn't carry the same tapering concerns as a steroid, it's also sometimes continued for longer stretches without the same worry about extended daily use that comes up with topical corticosteroids.

Where Crisaborole Sits on the Eczema Treatment Ladder

Crisaborole sits in the topical treatment tier alongside topical corticosteroids and topical calcineurin inhibitors, one of several options guidelines describe for managing mild-to-moderate atopic dermatitis before more intensive systemic treatment becomes necessary 1. It's not usually the first thing tried — topical corticosteroids remain the default first-line topical treatment for most flares because they tend to act faster — but crisaborole becomes a reasonable option when steroid use needs to be limited, when a steroid alone isn't fully controlling a mild-to-moderate case, or when someone is using it as part of a longer-term maintenance plan rather than treating a single flare 1. For someone managing eczema mainly with intermittent steroid use for flares, adding crisaborole into the rotation can also reduce the total number of days spent on a steroid over a given month, which matters most for skin already showing signs of steroid-related thinning.

Why Nonsteroidal Matters in Sensitive Areas

The appeal of a nonsteroidal option becomes clearest on skin that's thinner or more sensitive to steroid side effects — the face, eyelids, neck, and skin folds like the armpits or groin, where a topical steroid strong enough to work well elsewhere on the body may not be appropriate for regular or prolonged use. Crisaborole doesn't carry that same skin-thinning concern, which makes it a more comfortable option for ongoing use in these locations, though it isn't without its own downside: a stinging or burning sensation on application is common, especially early in treatment, and it's one of the more frequent reasons people stop using it before giving it a full trial. People managing eczema around the eyes specifically often gravitate toward crisaborole precisely because that's one of the areas where steroid caution is most pronounced, and a slower-acting option that's safe for repeated use there can be worth the tradeoff.

Crisaborole Compared to Steroids and Calcineurin Inhibitors

Compared with topical corticosteroids, crisaborole generally works more slowly and, for many people, less completely — a real tradeoff for its more favorable long-term safety profile in sensitive areas 1. Compared with topical calcineurin inhibitors like tacrolimus and pimecrolimus, which work through yet another mechanism and are also steroid-sparing options guidelines group alongside crisaborole in the same topical, nonsteroidal category, the choice between them often comes down to individual tolerance — some people find one stings less than another — and clinician preference, since guidelines describe them as parallel options within the same tier rather than ranking one above the others 1. None of these topical options are mutually exclusive over time — it's common for someone to use a topical steroid during an active flare, then transition to crisaborole or a calcineurin inhibitor for maintenance once the worst of the inflammation has settled.

Combining Crisaborole With Moisturizer

Moisturizer isn't optional alongside crisaborole; it's part of the same treatment plan. Consistent use of a bland, fragrance-free emollient improves eczema outcomes on its own, extends the time before a flare returns, and reduces how much active medication — steroid or otherwise — is needed to keep skin calm 2. Applying moisturizer generously alongside crisaborole supports the skin barrier while the medication works on the inflammation itself, and skipping the moisturizing step tends to undercut how well any topical eczema treatment performs, crisaborole included. Cost and insurance coverage also factor into this decision in practice, since crisaborole is a newer, brand-name option that isn't always covered as readily as a generic topical steroid, which can make it a second-line choice for reasons that have nothing to do with how well it works.

What Happens If Crisaborole Isn't Enough

For eczema that stays active despite a fair trial of topical treatment — crisaborole, steroids, and calcineurin inhibitors together — the next step on the ladder moves to phototherapy or systemic treatment: oral immunosuppressants, biologics like dupilumab, or an oral JAK inhibitor, depending on severity and other health factors 3. That's a meaningfully bigger step than switching between topical options, and it's usually reserved for eczema that's moderate to severe and clearly not controlled by the topical tier rather than something tried after one disappointing week on crisaborole. This progression also isn't necessarily permanent — some people move to a systemic treatment during a difficult stretch and step back down to topical maintenance, crisaborole included, once the disease is better controlled.

What a Realistic Timeline Looks Like

Atopic dermatitis is a condition driven by immune dysregulation and skin-barrier dysfunction, and it follows a chronic, relapsing course rather than a single resolved episode 4. Crisaborole, like every topical eczema treatment, manages flares and reduces their frequency rather than curing that underlying tendency. Visible improvement with crisaborole often takes longer to appear than with a topical steroid, so a fair trial usually means sticking with consistent use for several weeks before judging whether it's working, rather than switching options after only a few days of stinging and no obvious change. Tracking how skin looks at a consistent interval, rather than checking daily and getting discouraged by day-to-day fluctuation that has more to do with normal variability than treatment failure, tends to give a clearer picture of whether crisaborole is actually helping.

Common questions

No. Crisaborole is a topical phosphodiesterase-4 (PDE4) inhibitor, a different drug class that doesn't work through the same pathway as a topical corticosteroid and doesn't carry the same skin-thinning risk with prolonged use. It's grouped with steroids and calcineurin inhibitors as a topical eczema treatment option, but the mechanism and safety profile are distinct.

A stinging or burning sensation on application is a common side effect, especially in the first days or weeks of use, and it's one of the more frequent reasons people stop before giving it a full trial. It tends to lessen with continued use for many people, though persistent or severe stinging is worth discussing with a prescriber.

Visible improvement typically takes longer to appear than with a topical steroid, so a fair trial generally means consistent twice-daily use for several weeks rather than judging results after a few days. Sticking with it through the initial stinging phase is often necessary to see whether it's actually helping.

Yes, and that's one of its more common uses, since it doesn't carry the skin-thinning risk associated with prolonged topical steroid use on thinner facial skin. It's frequently chosen for eczema around the eyes, mouth, and neck for this reason.

If eczema stays active despite consistent use of crisaborole and other topical options, the next step on the treatment ladder typically involves phototherapy or a systemic treatment like a biologic or oral JAK inhibitor, reserved for eczema that topical treatment alone isn't controlling. That's a decision made with a dermatologist based on how much skin is affected and how it's impacting daily life.

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When eczema needs more than a topical treatment

  • —Eczema covering a large portion of the body or clearly worsening despite consistent topical treatment
  • —Signs of skin infection — increasing warmth, spreading redness, oozing, or fever — at the eczema site
  • —Sleep loss or significant daily-life disruption from itching that isn't improving with current treatment
  • —A severe stinging or allergic-type reaction after applying crisaborole

This article is general health information, not medical advice. It cannot tell you whether crisaborole is right for your eczema. A dermatologist who knows your history and the severity of your eczema is the right source for that decision.

References

  1. 1.Sidbury R, Alikhan A, Bercovitch L, et al. (2023). Guidelines of care for the management of atopic dermatitis in adults with topical therapies. Journal of the American Academy of Dermatology. doi:10.1016/j.jaad.2022.12.029Crisaborole, alongside topical corticosteroids and calcineurin inhibitors, is a guideline-recognized topical treatment option for atopic dermatitis.
  2. 2.van Zuuren EJ, Fedorowicz Z, Christensen R, et al. (2017). Emollients and moisturisers for eczema. Cochrane Database of Systematic Reviews. PMID 28432721 ✓Moisturizers improve eczema outcomes, extend time to flare, and reduce the amount of active medication needed alongside them.
  3. 3.Sidbury R, Davis DM, Alikhan A, et al. (2024). Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies. Journal of the American Academy of Dermatology. PMID 37943240Phototherapy and systemic treatments — including dupilumab, other biologics, and oral JAK inhibitors — are the next tier for atopic dermatitis not controlled by topical treatment.
  4. 4.National Institute of Allergy and Infectious Diseases (2024). Eczema (Atopic Dermatitis). NIH / NIAID. link ✓Atopic dermatitis is a condition involving immune dysregulation and skin-barrier dysfunction, with a chronic, relapsing course.

4 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — citations link their sources. Editorial policy

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