Tapinarof Versus Crisaborole for Pediatric Atopic Dermatitis: A Systematic Review and Meta-Analysis

Background: A chronic inflammatory skin ailment marked by pruritus and eczematous lesions, atopic dermatitis (AD) greatly lowers patient quality of life. Alternatives to corticosteroids have surfaced in nonsteroidal topical medicines such crisaborole and tapinarof, which provide focused anti-inflammatory effects with fewer general adverse effects. Objective: The aim of this systematic review and meta-analysis was to assess and contrast the safety and efficacy profiles of crisaborole and tapinarof in the management of mild to moderate AD. Methodology: A search of several databases produced 510 studies, after removing duplicates and applying eligibility criteria, 24 studies including a pooled sample of 8,218 patients (average age 17.5 years) were included. Using the Investigator's Static Global Assessment (ISGA) and Eczema Area and Severity Index (EASI), efficacy outcomes were evaluated; safety was based on incidence of adverse events. Results: Among 1,164 patients receiving crisaborole, 61% (95% CI: 44-76%) achieved ISGA 0-1; 49% (95% CI: 43-55%) in the tapinarof group having no statistically significant difference (Chi=1.70, P=0.192). Similarly, 60% (95% CI: 55-65%) of crisaborole patients and 66% (95% CI: 53-82%) of those on tapinarof showed EASI improvement with no significant variation (Chi=1.11, P=0.293). Overall, 45% reported side effects (95% CI: 31-60%); comparable between crisaborole (38%) and tapinarof (62%) (Chi=1.03, P=0.309). Rare severe events and therapy discontinuation occurred for both drugs. Conclusion: Mild to moderate AD may be effectively and safely managed with either crisaborole or tapinarof. With no major efficacy or safety differences, treatment choice can be guided by patient preference, tolerability, and clinical context.