In July of 2024, the FDA approved Zoryve® cream (roflumilast) for the treatment of mild to moderate eczema in adults and children ages 6 and older. It has also been used to treat plaque psoriasis since 2022. Zoryve® is also available as a foam which was approved in 2023 for the treatment of seborrheic dermatitis in patients 9 years of age and older. Zoryve® is available by prescription only.
How it Works
The cream is used once daily, is steroid-free, and is made by Arcutis Biotherapeutics. Its active ingredient, roflumilast, is a phosphodiesterase-4 inhibitor (PE4 inhibitor). Here’s how it works:
Your body makes an enzyme called phosphodiesterase-4 or PDE-4. PDE-4 gets in the way of a chemical reaction called cyclic adenosine monophosphate (cAMP). This interference raises the inflammation in your body. Blocking PDE-4 raises cAMP activity and lowers inflammation. This is the mechanism that reduces the symptoms of eczema, psoriasis, and seborrheic dermatitis.
Advantages of Zoryve®
After four weeks, eczema subjects using roflumilast cream experienced significantly greater symptom reduction — including improved itch and clearer skin — than those using the plain vehicle cream.
For those with psoriasis, most people achieved significantly clearer skin after eight weeks, as opposed to those using the plain vehicle cream. In addition, 68% had significant itch relief at eight weeks.
Disadvantages of Zoryve
Zoryve® is effective in symptom relief only. Using Zoryve® can result in side effects, the most common being diarrhea, nausea, headache, trouble sleeping, upper respiratory tract infections, urinary tract infections, and pain at the application site.
Zoryve® is for topical use only. Do not apply it to your eyes, mouth or vagina. Those who have liver problems should not use Zoryve® before discussing possible contraindications with their physician. At this time, it is not known whether Zoryve® passes through the breast milk or harms unborn babies, so if you are pregnant or nursing, be sure to let your doctor know. It is also unknown whether Zoryve® is safe for children under 6 years old.
The cash cost for 60 grams of Zoryve® 0.3% topical cream is around $949 before insurance or discounts. At this time of this writing, a generic version of the cream is not available.
Our Recommendation: Use Caution and Conservatism
With any chronic health condition, a conservative care approach is best. What does that mean? It means working with your healthcare professional to find the root cause of your condition and then treating it with interventions that are the least intrusive, and least damaging, but still provide the best results. More invasive and risky treatments, like high-risk pharmaceutical treatments, should only be contemplated when all other treatments have failed and only after all pros and cons have been carefully considered.
Unfortunately, for many patients with skin conditions, the available choices of prescription drugs often fail the conservative care test. Their side effects can be extreme, compromising your health in other areas. They can be cost-prohibitive, even with insurance. Worst of all, they typically manage or mask the symptoms of eczema, TSW, acne, or psoriasis versus treating the root cause. This means you will likely need to use these pharmaceuticals continuously.
So, if you have tried everything to no avail and find yourself at the crossroads on whether or not to embark on a new drug therapy, we offer one other alternative to consider that is safer: Traditional Chinese Medicine (TCM) herbal medicine.
What TCM Can Do
TCM not only reduces the symptoms of eczema and psoriasis for many patients, but it also treats the root cause and brings the whole health of patients back into balance so they can experience their healthy natural skin again. It has no negative side effects and provides results that last even after cessation of treatment, with no withdrawal symptoms.
Positive Side Effects with TCM?
The “side effects” of herbal medicine are actually very positive. Herbal medicine dermatology patients report that other health issues (insomnia, digestion, allergies, PMS, and more) have concurrently improved with treatment. This is because when we take into consideration every system that contributes to the skin, instead of just focusing on the surface skin symptom, we treat the whole body. Therefore, it makes sense that other body functions would improve as well.
The other positive aspect of herbal medicine treatment is that its goal is returning the skin to normal function so that you can stop all treatment and maintain your healthy natural skin without assistance. TCM is interested in condition resolution, not symptom management.
Protect Your Long-Term Health
If you’ve struggled with eczema or psoriasis for a long time, it can be tempting to reach for anything that promises instant relief. However, your long-term health and well-being are priceless beyond measure. You owe it to yourself to consult with more than one professional before embarking on a high-risk pharmaceutical therapy if your life is not at stake.
And if you are currently on any prescription drugs to manage your skin and are wondering if it’s the right long-term solution for you, know that it’s possible to wean off your prescription therapy safely, and substitute more natural therapies that may deliver similar or even better results.
There are lots of choices and every day, there are more! We hope that sharing the facts about new eczema and psoriasis drugs will help you make a choice that is best for you on every level.
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About the Author
Olivia Hsu Friedman, LAc, Dipl.OM, DACM, Cert. TCMDerm, is the owner of Amethyst Holistic Skin Solutions and treats Acne, Eczema, Psoriasis, and TSW. Olivia treats patients via video conferencing using only herbal medicine. Olivia is Chair of the Board of Directors of the American Society of Acupuncturists, serves on the Advisory Board of LearnSkin, and is a faculty member of the Chicago Integrative Eczema Group sponsored by the National Eczema Association.