First, the honest framing
"Newer" is not a synonym for "better", and it is not a synonym for "safer". A newer medicine has less real-world history behind it, which cuts both ways. What these options genuinely offer is choice — something to try when a steroid isn't working, isn't suitable for the area, or isn't something you want to keep using. That is worth a lot, and it is a different claim from "better".
Crisaborole (Eucrisa)
A PDE4-inhibitor ointment, approved for patients 3 months of age and older, and usable on more than one area of the body. It is the oldest of the four and the one most likely to have already been mentioned to you.
Roflumilast cream (Zoryve)
Also a PDE4 inhibitor. Approved for ages 2 and up for mild-to-moderate disease, and described by the AAD as rapidly reducing itch. The most common side effects listed are headache, nausea, and pain where the medication was applied.
Tapinarof cream (Vtama)
Approved for ages 2 and up, and — unusually for a topical — for mild, moderate or severe disease. The AAD notes rapid relief from itch, sometimes within 24 hours. Most common side effects listed: a respiratory tract infection, folliculitis (inflamed hair follicles), and headache.
Ruxolitinib cream (Opzelura)
A topical JAK inhibitor, approved for ages 2 and up for mild-to-moderate disease. Because it belongs to the JAK class, it carries that class's boxed warning on its label — which is a serious enough subject that it has its own guide here. Read that before this one if a JAK cream is what's being discussed.
Both roflumilast and tapinarof are in the 2025 guideline update
The AAD's 2025 focused update on managing atopic dermatitis in adults developed strong recommendations for tapinarof cream and roflumilast cream (alongside two newer biologics), used with concomitant topical therapy. That is a meaningful signal — it means these are not fringe options but part of the recommended landscape.
What to ask
- "Is there a non-steroid option that suits this area?" — particularly for the face, eyelids, and skin folds, where steroid choices are more constrained. See the face and eyelids.
- "What are we expecting, and by when?" A clear expectation makes it possible to tell working from not-working, instead of drifting for months.
- "What does this cost me, and is it covered?" Newer topicals are frequently the ones insurance argues about. Our guide on prior authorization and appeals exists for exactly that.
What you should not do is decide between these from a web page. Every one of them has an approved age range, an approved severity range and its own side-effect profile, and matching those to you is the entire job of the person prescribing.
Know whether the new one is actually working
Switching topicals is the moment a record earns its keep. Ollowen ties what you used to what the skin did afterwards, so at the follow-up you can say what happened over eight weeks instead of guessing from the last bad day.
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Sources
- American Academy of Dermatology. Atopic dermatitis: diagnosis and treatment.
- American Academy of Dermatology. Atopic dermatitis clinical guidelines (2025 focused update).
- Focused update: guidelines of care for the management of atopic dermatitis in adults. J Am Acad Dermatol, 2025.
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