Roflumilast
Roflumilast
The highest response rates in this register, the cleanest tolerability in it, and the worst price in it. All three at once.
The marker is the strength the trials were actually run at. The bar is the span this register has recorded, approved and compounded together. Anything below the marker is a dose nobody has tested; anything above it is an assumption about a dose–response curve nobody has drawn.
The shaded band is the depth this molecule is understood to reach. Anything below it is out of scope, whatever the label says.
Mechanism
Inhibits PDE4, raising intracellular cyclic AMP and suppressing the inflammatory cytokine cascade. Because it acts through no corticosteroid receptor, it carries none of the atrophy or telangiectasia constraints that limit facial steroid use.
HOUSE NOTES
- Applied daily to inflamed facial skin and scalp for eight weeks across 458 subjects, no local skin reaction reached 1%. What appears instead — nausea, headache, diarrhoea — is the systemic signature of PDE4 inhibition.
- The seborrhoeic dermatitis vehicle arm reached 58%, the highest in this register. A bland foam applied consistently does a great deal.
- Steroid-free matters here: seborrhoeic dermatitis is lifelong and relapsing, and a facial corticosteroid cannot be used that way.
- 408 subjects continued for 24 to 52 weeks with a consistent profile — one of only two molecules here with year-scale data.
MEASURED ENDPOINTS
SUPPORTING RECORDS
Randomised 2:1, vehicle-controlled; treatment difference 20.6% (95% CI 11.2–30.0)
N=457 · 8 WK · DOUBLE-BLIND
Randomised 2:1, vehicle-controlled; treatment difference 37.1% (95% CI 27.1–47.1)
N=432 · 8 WK · DOUBLE-BLIND
Layering
- Moderate to severe liver impairment — contraindicated
- Fire, flame and smoking during application
- Antifungal shampoo
- A bland moisturiser