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| Name | Class |
|---|---|
| Pfizer | INDUSTRY |
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Atopic dermatitis, or eczema, is a chronic skin condition affecting many children. Crisaborole is a non-steroid topical medication which is FDA approved for children aged 2 and older for eczema. This research study seeks to investigate whether crisaborole reduces topical steroid use in children with atopic dermatitis.
Atopic dermatitis (AD) is a chronic skin disease and a common affliction among children. Twice daily topical corticosteroid (TCS) use over several weeks is recommended for active inflammatory disease. Side effects of TCS range from cutaneous atrophy to hypothalamic-pituitary-adrenal axis suppression. Steroid phobia and misunderstanding often lead to poor compliance and inadequate disease control. Topical calcineurin inhibitors (TCIs) are currently recommended as steroid-reducing agents, especially on sensitive areas such as the face and skin folds. However, TCis are associated with burning reactions and come with black box warnings.
Crisaborole (Eucrisa), the newest topical prescription option for AD, is a phosphodiesterase-4 inhibitor with demonstrated efficacy in patients aged 2 and older with mild to moderate AD. Given the good tolerability and favorable safety profile, crisaborole makes for an alternative topical option to its predecessors. However, corresponding data are lacking. It would be of great interest to patients, patients' families and providers if crisaborole can be shown to reduce the amount of TCS necessary for control of AD. The investigators therefore propose a proof-of-concept study to investigate whether crisaborole can serve as an effective steroid-reducing agent.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Crisaborole | Active Comparator | Participants will be instructed to apply emollient, topical steroid, and or crisaborole (blinded) to affected areas with eczema. |
|
| Vehicle | Placebo Comparator | Participants will be instructed to apply emollient, topical steroid, and or vehicle (blinded) to affected areas with eczema. |
|
| Control | Sham Comparator | Participants will be instructed to apply emollient, topical steroid, and or emollient (blinded) to affected areas with eczema. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Crisaborole | Drug | Participants will be instructed to apply crisaborole to affected areas with eczema. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Steroid Usage Quantity | Steroid usage measured in medication weight (grams) | Day 30 |
| Steroid Usage Quantity | Steroid usage measured in medication weight (grams) | Day 90 |
| Steroid Usage Frequency | Steroid usage measured in diary entries. Weekly average frequency of steroid use is reported. | Day 30 |
| Steroid Usage Frequency | Steroid usage measured in diary entries. Weekly average frequency of steroid use is reported. | Day 90 |
| Measure | Description | Time Frame |
|---|---|---|
| Eczema Severity as Assessed by SCORing Atopic Dermatitis (SCORAD) Score | Clinical assessment using SCORAD score: minimum score = 0, maximum score = 103. Highest score corresponds with highest severity of eczema. Lowest score corresponds with lowest severity of eczema. | Day 0 |
| Eczema Severity Assessed by SCORAD Score |
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Inclusion criteria:
Exclusion criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Anna Grossberg, MD | Johns Hopkins University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Johns Hopkins Hospital | Baltimore | Maryland | 21287 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 27417017 | Background | Paller AS, Tom WL, Lebwohl MG, Blumenthal RL, Boguniewicz M, Call RS, Eichenfield LF, Forsha DW, Rees WC, Simpson EL, Spellman MC, Stein Gold LF, Zaenglein AL, Hughes MH, Zane LT, Hebert AA. Efficacy and safety of crisaborole ointment, a novel, nonsteroidal phosphodiesterase 4 (PDE4) inhibitor for the topical treatment of atopic dermatitis (AD) in children and adults. J Am Acad Dermatol. 2016 Sep;75(3):494-503.e6. doi: 10.1016/j.jaad.2016.05.046. Epub 2016 Jul 11. | |
| 24813302 |
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| ID | Title | Description |
|---|---|---|
| FG000 | Crisaborole | Crisaborole is chosen because it is the newest non-steroid FDA-approved prescription topical medication for treatment of mild to moderate AD in children 2 years of age and older. The FDA-approved dosage is application of a thin layer twice daily to affected areas. Hydrocortisone and triamcinolone are chosen because these are commonly prescribed topical steroids for treatment of mild to moderate AD in children 2 years of age and older. Hydrocortisone is a low-potency topical steroid, and triamcinolone is a mid-potency topical steroid. The FDA-approved dosage for hydrocortisone and triamcinolone is application of a thin layer twice daily to affected areas. Crisaborole: Participants will be instructed to apply crisaborole to affected areas with eczema. In the crisaborole group, the parents will be provided with crisaborole (with unidentifiable packaging) with refills as needed. As for twice daily topical corticosteroid (TCS), triamcinolone acetonide 0.1% ointment and hydrocortisone 2.5% ointment will be provided, with refills as needed. Aquaphor is to be applied for maintenance. Crisaborole will be used as the first-line agent for AD lesions. TCS will be used as the second-line agent for AD lesions. |
| FG001 | Vehicle | Crisaborole vehicle is chosen because this contains only the inactive ingredients found in crisaborole, to serve as placebo. Hydrocortisone and triamcinolone are chosen because these are commonly prescribed topical steroids for treatment of mild to moderate AD in children 2 years of age and older. Hydrocortisone is a low-potency topical steroid, and triamcinolone is a mid-potency topical steroid. The FDA-approved dosage for hydrocortisone and triamcinolone is application of a thin layer twice daily to affected areas. In the vehicle group, parents will be provided vehicle (non-medicated ointment) with unidentifiable packaging, with refills as needed. They will also have triamcinolone acetonide 0.1% ointment and hydrocortisone 2.5% ointment provided, with refills as needed. They will be provided identical instructions to the crisaborole group with regard to usage of the vehicle and TCS. |
| FG002 | Control | Aquaphor is chosen because this is a skin moisturizer which is routinely used by patients with AD. Hydrocortisone and triamcinolone are chosen because these are commonly prescribed topical steroids for treatment of mild to moderate AD in children 2 years of age and older. Hydrocortisone is a low-potency topical steroid, and triamcinolone is a mid-potency topical steroid. The FDA-approved dosage for hydrocortisone and triamcinolone is application of a thin layer twice daily to affected areas. In the control group, parent(s) will be provided control (Aquaphor) in unidentifiable packaging, with refills as needed. They will also be provided triamcinolone acetonide 0.1% ointment and hydrocortisone 2.5% ointment, with refills as needed. They will be given identical instructions to the crisaborole and vehicle groups with regard to usage of TCS. |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Crisaborole | Participants will be instructed to apply emollient, topical steroid, and or crisaborole (blinded) to affected areas with eczema. Crisaborole: Participants will be instructed to apply crisaborole to affected areas with eczema. Hydrocortisone Ointment: Participants will be instructed to apply hydrocortisone to affected areas with eczema on face, armpits or groin. Triamcinolone ointment: Participants will be instructed to apply triamcinolone to affected areas on the body excluding face, armpits or groin. Aquaphor: Participants will be instructed to moisturize all over the body with Aquaphor. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Steroid Usage Quantity | Steroid usage measured in medication weight (grams) | 3 withdrew, 7 lost to followup | Posted | Mean | Standard Deviation | grams | Day 30 |
|
Up to 104 days
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Crisaborole | Crisaborole is chosen because it is the newest non-steroid FDA-approved prescription topical medication for treatment of mild to moderate AD in children 2 years of age and older. The FDA-approved dosage is application of a thin layer twice daily to affected areas. Hydrocortisone and triamcinolone are chosen because these are commonly prescribed topical steroids for treatment of mild to moderate AD in children 2 years of age and older. Hydrocortisone is a low-potency topical steroid, and triamcinolone is a mid-potency topical steroid. The FDA-approved dosage for hydrocortisone and triamcinolone is application of a thin layer twice daily to affected areas. Crisaborole: Participants will be instructed to apply crisaborole to affected areas with eczema. In the crisaborole group, the parents will be provided with crisaborole (with unidentifiable packaging) with refills as needed. As for twice daily topical corticosteroid (TCS), triamcinolone acetonide 0.1% ointment and hydrocortisone 2.5% ointment will be provided, with refills as needed. Aquaphor is to be applied for maintenance. Crisaborole will be used as the first-line agent for AD lesions. TCS will be used as the second-line agent for AD lesions. |
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| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| burning sensation after the first application of the assigned study medication. | Skin and subcutaneous tissue disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Ruizhi Wang | Cutaneous Translational Research Program | 4105027546 | rwang@jhmi.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Sep 18, 2020 | Dec 12, 2023 | Prot_SAP_000.pdf |
| ICF | No | No | Yes | Informed Consent Form | Sep 14, 2020 | Dec 12, 2023 | ICF_001.pdf |
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| ID | Term |
|---|---|
| D003876 | Dermatitis, Atopic |
| D004485 | Eczema |
| ID | Term |
|---|---|
| D012873 | Skin Diseases, Genetic |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D003872 | Dermatitis |
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| ID | Term |
|---|---|
| C543085 | crisaborole |
| D010577 | Petrolatum |
| ID | Term |
|---|---|
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
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| Hydrocortisone Ointment | Drug | Participants will be instructed to apply hydrocortisone to affected areas with eczema on face, armpits or groin. |
|
| Triamcinolone ointment | Drug | Participants will be instructed to apply triamcinolone to affected areas on the body excluding face, armpits or groin. |
|
| Aquaphor | Drug | Participants will be instructed to moisturize all over the body with Aquaphor. |
|
Clinical assessment using SCORAD score: minimum score = 0, maximum score = 103. Higher score corresponds with increased severity of eczema. Lowest score corresponds with lowest severity of eczema. |
| Day 30 |
| Eczema Severity Assessed by SCORAD Score | Clinical assessment using SCORAD score: minimum score = 0, maximum score = 103. Higher score corresponds with increased severity of eczema. Lowest score corresponds with lowest severity of eczema. | Day 90 |
| Quality of Life for Participant as Assessed by Children's Dermatology Life Quality Index | Children's Dermatology Life Quality Index (ages 15 or younger). The minimum score is 0, maximum score is 30. The highest score corresponds with most severe impairment of quality of life. The lowest score corresponds with lowest impairment of quality of life. | Day 0 |
| Quality of Life for Participant as Assessed by Children's Dermatology Life Quality Index | Children's Dermatology Life Quality Index (ages 15 or younger). The minimum score is 0, maximum score is 30. The highest score corresponds with most severe impairment of quality of life. The lowest score corresponds with lowest impairment of quality of life. | Day 30 |
| Quality of Life for Participant as Assessed by Children's Dermatology Life Quality Index | Children's Dermatology Life Quality Index (ages 15 or younger). The minimum score is 0, maximum score is 30. The highest score corresponds with most severe impairment of quality of life. The lowest score corresponds with lowest impairment of quality of life. | Day 90 |
| Quality of Life for Family as Assessed by Dermatitis Family Impact Questionnaire | Dermatitis Family Impact Questionnaire. Minimum score is 0, maximum score is 30. The highest score corresponds with most severe impairment of quality of life. The lowest score corresponds with lowest impairment of quality of life. | Day 0 |
| Quality of Life for Family as Assessed by Dermatitis Family Impact Questionnaire | Dermatitis Family Impact Questionnaire. Minimum score is 0, maximum score is 30. The highest score corresponds with most severe impairment of quality of life. The lowest score corresponds with lowest impairment of quality of life. | Day 30 |
| Quality of Life for Family as Assessed by Dermatitis Family Impact Questionnaire | Dermatitis Family Impact Questionnaire. Minimum score is 0, maximum score is 30. The highest score corresponds with most severe impairment of quality of life. The lowest score corresponds with lowest impairment of quality of life. | Day 90 |
| Severity of Itching as Assessed by Pruritus Score | Pruritus score determined using Numerical Rating Scale. Minimum score is 0. Maximum score is 10. Lowest score means no itching. Highest score corresponds to the most severe itching imaginable by patient. | Day 0 |
| Severity of Itching as Assessed by Pruritus Score | Pruritus score determined using Numerical Rating Scale. Minimum score is 0. Maximum score is 10. Lowest score means no itching. Highest score corresponds to the most severe itching imaginable by patient. | Day 30 |
| Severity of Itching as Assessed by Pruritus Score | Pruritus score determined using Numerical Rating Scale. Minimum score is 0. Maximum score is 10. Lowest score means no itching. Highest score corresponds to the most severe itching imaginable by patient. | Day 90 |
| Background |
| Eichenfield LF, Tom WL, Berger TG, Krol A, Paller AS, Schwarzenberger K, Bergman JN, Chamlin SL, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Feldman SR, Hanifin JM, Margolis DJ, Silverman RA, Simpson EL, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014 Jul;71(1):116-32. doi: 10.1016/j.jaad.2014.03.023. Epub 2014 May 9. |
| BG001 | Vehicle | Participants will be instructed to apply emollient, topical steroid, and or vehicle (blinded) to affected areas with eczema. Hydrocortisone Ointment: Participants will be instructed to apply hydrocortisone to affected areas with eczema on face, armpits or groin. Triamcinolone ointment: Participants will be instructed to apply triamcinolone to affected areas on the body excluding face, armpits or groin. Aquaphor: Participants will be instructed to moisturize all over the body with Aquaphor. |
| BG002 | Control | Participants will be instructed to apply emollient, topical steroid, and or emollient (blinded) to affected areas with eczema. Hydrocortisone Ointment: Participants will be instructed to apply hydrocortisone to affected areas with eczema on face, armpits or groin. Triamcinolone ointment: Participants will be instructed to apply triamcinolone to affected areas on the body excluding face, armpits or groin. Aquaphor: Participants will be instructed to moisturize all over the body with Aquaphor. |
| BG003 | Total | Total of all reporting groups |
| years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| OG001 | Vehicle | Crisaborole vehicle is chosen because this contains only the inactive ingredients found in crisaborole, to serve as placebo. Hydrocortisone and triamcinolone are chosen because these are commonly prescribed topical steroids for treatment of mild to moderate AD in children 2 years of age and older. Hydrocortisone is a low-potency topical steroid, and triamcinolone is a mid-potency topical steroid. The FDA-approved dosage for hydrocortisone and triamcinolone is application of a thin layer twice daily to affected areas. In the vehicle group, parents will be provided vehicle (non-medicated ointment) with unidentifiable packaging, with refills as needed. They will also have triamcinolone acetonide 0.1% ointment and hydrocortisone 2.5% ointment provided, with refills as needed. They will be provided identical instructions to the crisaborole group with regard to usage of the vehicle and TCS. |
| OG002 | Control | Aquaphor is chosen because this is a skin moisturizer which is routinely used by patients with AD. Hydrocortisone and triamcinolone are chosen because these are commonly prescribed topical steroids for treatment of mild to moderate AD in children 2 years of age and older. Hydrocortisone is a low-potency topical steroid, and triamcinolone is a mid-potency topical steroid. The FDA-approved dosage for hydrocortisone and triamcinolone is application of a thin layer twice daily to affected areas. In the control group, parent(s) will be provided control (Aquaphor) in unidentifiable packaging, with refills as needed. They will also be provided triamcinolone acetonide 0.1% ointment and hydrocortisone 2.5% ointment, with refills as needed. They will be given identical instructions to the crisaborole and vehicle groups with regard to usage of TCS. |
|
|
| Primary | Steroid Usage Quantity | Steroid usage measured in medication weight (grams) | 3 withdrew, 9 lost to followup | Posted | Mean | Standard Deviation | grams | Day 90 |
|
|
|
| Primary | Steroid Usage Frequency | Steroid usage measured in diary entries. Weekly average frequency of steroid use is reported. | Posted | Mean | Standard Deviation | steroids used per week | Day 30 |
|
|
|
| Primary | Steroid Usage Frequency | Steroid usage measured in diary entries. Weekly average frequency of steroid use is reported. | Participants lost to follow-up in recording diaries, data not collected. | Posted | Mean | Standard Deviation | steroids used per week | Day 90 |
|
|
|
| Secondary | Eczema Severity as Assessed by SCORing Atopic Dermatitis (SCORAD) Score | Clinical assessment using SCORAD score: minimum score = 0, maximum score = 103. Highest score corresponds with highest severity of eczema. Lowest score corresponds with lowest severity of eczema. | Posted | Mean | Standard Deviation | score on a scale | Day 0 |
|
|
|
| Secondary | Eczema Severity Assessed by SCORAD Score | Clinical assessment using SCORAD score: minimum score = 0, maximum score = 103. Higher score corresponds with increased severity of eczema. Lowest score corresponds with lowest severity of eczema. | There were some lost-to-follow up after Day 0. | Posted | Mean | Standard Deviation | score on a scale | Day 30 |
|
|
|
| Secondary | Eczema Severity Assessed by SCORAD Score | Clinical assessment using SCORAD score: minimum score = 0, maximum score = 103. Higher score corresponds with increased severity of eczema. Lowest score corresponds with lowest severity of eczema. | Posted | Mean | Standard Deviation | score on a scale | Day 90 |
|
|
|
| Secondary | Quality of Life for Participant as Assessed by Children's Dermatology Life Quality Index | Children's Dermatology Life Quality Index (ages 15 or younger). The minimum score is 0, maximum score is 30. The highest score corresponds with most severe impairment of quality of life. The lowest score corresponds with lowest impairment of quality of life. | Some participants were lost to follow-up, data not collected. | Posted | Mean | Standard Deviation | score on a scale | Day 0 |
|
|
|
| Secondary | Quality of Life for Participant as Assessed by Children's Dermatology Life Quality Index | Children's Dermatology Life Quality Index (ages 15 or younger). The minimum score is 0, maximum score is 30. The highest score corresponds with most severe impairment of quality of life. The lowest score corresponds with lowest impairment of quality of life. | Some participants were lost to follow-up, data not collected. | Posted | Mean | Standard Deviation | score on a scale | Day 30 |
|
|
|
| Secondary | Quality of Life for Participant as Assessed by Children's Dermatology Life Quality Index | Children's Dermatology Life Quality Index (ages 15 or younger). The minimum score is 0, maximum score is 30. The highest score corresponds with most severe impairment of quality of life. The lowest score corresponds with lowest impairment of quality of life. | Posted | Mean | Standard Deviation | score on a scale | Day 90 |
|
|
|
| Secondary | Quality of Life for Family as Assessed by Dermatitis Family Impact Questionnaire | Dermatitis Family Impact Questionnaire. Minimum score is 0, maximum score is 30. The highest score corresponds with most severe impairment of quality of life. The lowest score corresponds with lowest impairment of quality of life. | Some participants were lost to follow-up, data not collected. | Posted | Mean | Standard Deviation | score on a scale | Day 0 |
|
|
|
| Secondary | Quality of Life for Family as Assessed by Dermatitis Family Impact Questionnaire | Dermatitis Family Impact Questionnaire. Minimum score is 0, maximum score is 30. The highest score corresponds with most severe impairment of quality of life. The lowest score corresponds with lowest impairment of quality of life. | Some participants were lost to follow-up, data not collected. | Posted | Mean | Standard Deviation | score on a scale | Day 30 |
|
|
|
| Secondary | Quality of Life for Family as Assessed by Dermatitis Family Impact Questionnaire | Dermatitis Family Impact Questionnaire. Minimum score is 0, maximum score is 30. The highest score corresponds with most severe impairment of quality of life. The lowest score corresponds with lowest impairment of quality of life. | Posted | Mean | Standard Deviation | score on a scale | Day 90 |
|
|
|
| Secondary | Severity of Itching as Assessed by Pruritus Score | Pruritus score determined using Numerical Rating Scale. Minimum score is 0. Maximum score is 10. Lowest score means no itching. Highest score corresponds to the most severe itching imaginable by patient. | Some participants were lost to follow-up, data not collected. | Posted | Mean | Standard Deviation | score on a scale | Day 0 |
|
|
|
| Secondary | Severity of Itching as Assessed by Pruritus Score | Pruritus score determined using Numerical Rating Scale. Minimum score is 0. Maximum score is 10. Lowest score means no itching. Highest score corresponds to the most severe itching imaginable by patient. | Some participants were lost to follow-up, data not collected. | Posted | Mean | Standard Deviation | score on a scale | Day 30 |
|
|
|
| Secondary | Severity of Itching as Assessed by Pruritus Score | Pruritus score determined using Numerical Rating Scale. Minimum score is 0. Maximum score is 10. Lowest score means no itching. Highest score corresponds to the most severe itching imaginable by patient. | Some participants were lost to follow-up, data not collected. | Posted | Mean | Standard Deviation | score on a scale | Day 90 |
|
|
|
| 0 |
| 8 |
| 0 |
| 8 |
| 1 |
| 8 |
| EG001 | Vehicle | Crisaborole vehicle is chosen because this contains only the inactive ingredients found in crisaborole, to serve as placebo. Hydrocortisone and triamcinolone are chosen because these are commonly prescribed topical steroids for treatment of mild to moderate AD in children 2 years of age and older. Hydrocortisone is a low-potency topical steroid, and triamcinolone is a mid-potency topical steroid. The FDA-approved dosage for hydrocortisone and triamcinolone is application of a thin layer twice daily to affected areas. In the vehicle group, parents will be provided vehicle (non-medicated ointment) with unidentifiable packaging, with refills as needed. They will also have triamcinolone acetonide 0.1% ointment and hydrocortisone 2.5% ointment provided, with refills as needed. They will be provided identical instructions to the crisaborole group with regard to usage of the vehicle and TCS. | 0 | 7 | 0 | 7 | 0 | 7 |
| EG002 | Control | Aquaphor is chosen because this is a skin moisturizer which is routinely used by patients with AD. Hydrocortisone and triamcinolone are chosen because these are commonly prescribed topical steroids for treatment of mild to moderate AD in children 2 years of age and older. Hydrocortisone is a low-potency topical steroid, and triamcinolone is a mid-potency topical steroid. The FDA-approved dosage for hydrocortisone and triamcinolone is application of a thin layer twice daily to affected areas. In the control group, parent(s) will be provided control (Aquaphor) in unidentifiable packaging, with refills as needed. They will also be provided triamcinolone acetonide 0.1% ointment and hydrocortisone 2.5% ointment, with refills as needed. They will be given identical instructions to the crisaborole and vehicle groups with regard to usage of TCS. | 0 | 9 | 0 | 9 | 0 | 9 |
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| D012871 | Skin Diseases |
| D017437 | Skin and Connective Tissue Diseases |
| D017443 | Skin Diseases, Eczematous |
| D006969 | Hypersensitivity, Immediate |
| D006967 | Hypersensitivity |
| D007154 | Immune System Diseases |