Alternative nonsteroidal therapies for occupational and environmental allergic skin disorders

Abstract

Topical corticosteroids (TCS) have long been considered as the first-line treatment for allergic skin diseases. Due to corticosteroids-related side effects and their contraindications, the search for alternative anti-inflammatory therapies has proven to be necessary. A mini-review on currently used and potential topical anti-allergic agents that are employed as alternatives to TCS and topical calcineurin inhibitors (TCI) with available clinical reports is done. In case of unsuccessful TCS and TCI therapy in AD patients, a systemic treatment or a phototherapy is often envisaged as next line of defense. For example, phototherapy (broadband UVB (290-320 nm), narrowband UVB (311-313 nm), UVA-1 (340-400 nm), UVA therapy plus 8-methoxypsoralen (PUVA), or full-spectrum light (FSL)) is mainly used to treat severe AD. Other anti-allergic agents currently in use are phosphodiesterase 4 (PDE4) inhibitors (crisaborole and apremilast which reduce the activity of PDE4 enzyme), anti-IgE agents (omalizumab and ligelizumab), IL-4 and IL-13 inhibitors (dupilumab), anti-TNF-a (etanercept, infliximab), and Janus kinase (JAK) inhibitors (e.g., JTE052). Probiotics and other potential anti-allergic plant materials are proposed for AD management; they include biomaterials extracted from Korean red ginseng, African Vernonia amygdalina Del., marine algal plants (Aphanothece sacrum), etc. Clinicians should consider each patient's history, clinical severity of disease, and the location of skin lesions prior to making a treatment choice.