Pearls in Mitigating Application Pain of Topical Nonsteroidal Agents

Steven Madsen, Kyla N. Price, Vivian Y. Shi, Peter A. Lio*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Background: Topical steroid-sparing agents (SSA), such as tacrolimus, pimecrolimus, and crisaborole, represent an important therapeutic option in the treatment of inflammatory dermatoses such as atopic dermatitis. While these agents lack the common side effects associated with topical corticosteroids, they all share application site pain as an important adverse effect. Summary: Based on the available evidence and our experience, we suggest the following 7 practical strategies for decreasing the pain associated with SSA use. (1) Use a topical corticosteroid for a few days to reduce inflammation before starting the SSA treatment. (2) Use SSAs strategically. (3) Apply moisturizer before applying SSAs. (4) Store moisturizers in the refrigerator. (5) Ask the patient to apply the SSA on a small test area before broader application. (6) Apply the SSA on dry rather than on damp skin. (7) Consider using aspirin when appropriate for the patient.

Original languageEnglish (US)
Pages (from-to)477-480
Number of pages4
Issue number5
StatePublished - Sep 1 2020


  • Inflammatory dermatoses
  • Pain
  • Topical nonsteroidal agents

ASJC Scopus subject areas

  • Dermatology


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