Magan Medical Clinic, Dermatology
We provide quality dermatology care with compassion. Our specialty is medical dermatology, including:
Note: Cosmetic treatments are not performed in Dermatology but instead by Maganís Medical Aesthetics Laser Center.
If you have psoriasis or hair questions, Dr. Chiang possesses special expertise. He completed fellowships in both fields at University of California, San Francisco where he saw a wide spectrum of patients (including the most severe), performed clinical trials, and published research.
We take pleasure in serving our community including Covina, West Covina, San Dimas, Rancho Cucamonga, Baldwin Park, Azusa, Glendora, Upland, El Monte, Duarte, Monrovia, Arcadia, La Puente, and Diamond Bar.
Same day appointments often available. No referral is necessary if you have PPO insurance. We accept a wide range of insurance plans (unfortunately, we do not accept Medi-Cal as primary insurance, only as secondary insurance).
For appointments, please call (626) 331-6411. We look forward to serving you!
"Whatís New in..."
A monthly column by Dr. Chiang
What's New in Eczema (atopic dermatitis)
Many patients (and for children, their parents) prefer to avoid topical steroids when possible for their itchy skin. While dermatologists agree that topical steroids are the mainstay first line treatment, I always try to accommodate patient preferences as possible. Unfortunately, there are only a few non-steroidal options. The mainstays have been tacrolimus ointment (brand name Protopic) and Elidel (no generic available) which are called calcineurin inhibitors. Their cons are that they are far weaker than steroids, can cause a burning sensation on application, are rarely covered by insurance, are very expensive out of pocket, and have a black box warning about causing lymphoma & skin cancer (which are not side effects of topical steroids).
That being said, itís always good to have more options. There is now a new non-steroidal ointment approved by the FDA and available as a prescription. Specifically, Eucrisa ointment (the generic crisaborole will not be available for many years) uses a new mechanism of being a phosphodiesterase 4 inhibitor, which decreases molecules involved in inflammation. Two placebo-controlled clinical trials have been published. In total, 1527 patients averaging age 12 and at least age 2 were enrolled for the 28 day trial. Efficacy was achieved, although mild to moderate from my standpoint, as expected from a non-steroid medication. Essentially, 32% significantly improved with the medication versus 22% with just the placebo ointment vehicle. Very simplified, that means very roughly 10% more improvement from the medication versus routinely moisturizing with an ointment. Another benefit was less skin infections were seen (which is also a benefit of steroidal medications) by healing the cracks through which bacteria penetrate.
Safety is the main question when using these non-steroidal medications as it is unlikely they will ever be more effective than steroids. Unfortunately, it was only a 28 day trial. Thus, safety cannot be guaranteed. I have not heard that the trial will be continued for a longer time, so weíll be dependent on anecdotal reports of safety (or side effects) over time to have a better idea. So far, no serious adverse events were reported. It had less burning on application (only 4.4%, which was 3% more than the vehicle alone) than other non-steroidal mediations (tacrolimus, Elidel). Safety is theorized to be promising as crisaborole is reported to have ďlow systemic absorption and is quickly metabolized to its inactive metabolites.Ē
The other question is insurance coverage and cost. One tube currently retails for about $600. Thus, it is not practical to pay out of pocket unless insurance covers it. Iíve written a few prescriptions so far (it has only been recently released). I do not have a good answer for this question yet, but itís worth trying to prescribe for the right patient.
If you have eczema or other skin issues, please make an appointment for dermatology consultation at (626) 331-6411 to discuss your options.
Charles Chiang, MD, FAAD
- Paller AS, et al. 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
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