Zest Health Guide to Topical Phosphodiesterase-4 (PDE4) Inhibitor

What are Topical PDE4 Inhibitors and How do They Work?

Topical PDE4 inhibitors are a non-steroidal class of treatment for eczema and psoriasis. They work by blocking an enzyme called phosphodiesterase-4 (PDE-4), which drives the overactive immune response that causes skin inflammation.

By calming that immune response, PDE4 inhibitors help reduce the redness, itching, and plaque buildup that can make flares so hard to live with.

Topical PDE-4 Inhibitor:

• Zoryve (roflumilast) — available as a cream or foam

Getting Started: Using Topical PDE4 Inhibitors Safely

Because Zoryve doesn’t contain steroids, it’s often a great option for areas where steroids may cause irritation. Your Zest provider will choose what’s right for you based on:

• Your specific skin condition
• The location of your rash
• The severity of your symptoms

While Zoryve is generally well-tolerated, it is important to follow your Zest treatment plan to ensure the best results with the lowest risk of side effects. It is FDA-approved for:

• Plaque Psoriasis: Adults and children 6 and older
• Atopic Dermatitis (Eczema): Adults and children 2 and older
• Seborrheic Dermatitis: Adults and children 9 and older

Applying Topical PDE4 Inhibitors  

Unlike many steroids, PDE4 inhibitors can generally be used on both thick and sensitive skin areas, including:

• Sensitive Areas: face, neck, armpits, groin, genitals, and skin folds
• Body: trunk, arms, and legs
• Persistent Areas: elbows, knees, and plaques

Application Tips:

A few simple habits will help you get the most from your treatment:

1. Wash your hands before and after applying — unless you’re treating your hands.
2. Apply to clean, dry skin, unless your provider directs otherwise.
3. Use a thin layer only on the affected areas, typically once daily.
4. Gently rub in until fully absorbed.
5. You can still use moisturizer to support your skin barrier — check with your provider on timing.

How Much Should I Use?

We recommend using the Fingertip Unit (FTU) when you are getting started:

• This is the amount of cream squeezed from the tip of your finger to the first crease.
• 1 FTU covers about the size of the front and back of one adult hand.
• Precision: If you are treating a very small spot, adjust the amount accordingly.

Different body parts need different amounts. If you are only treating a small area, you will use less. Your provider can walk you through the right amount for your specific areas.

Getting Started

• Submit baseline photos of your skin condition for a severity assessment.
• No routine blood work is needed, but please share all current and past medications with your provider.
• Provide previous treatment records if requested.

Expected Results

• Many people begin to see improvement within 2 to 4 weeks.
• Significant symptom relief is often reported by the 8 week mark.
• Once your skin is clear, your provider may suggest a long-term plan, which might include “weekend therapy” — applying medication once or twice a week to help prevent future flares.

Is it Safe/Are There Any Side Effects?

PDE-4 inhibitors do not cause skin thinning or stretch marks. However, some mild side effects can occur:

• Application site reactions (stinging or burning)
• Diarrhea or nausea
• Headache

Storing Your Medication

• Store at room temperature
• Keep tube or bottle tightly closed
• Keep out of reach of children
• Do not ingest medication
• Check expiration date before use

When to Contact Your Zest Team 

• No improvement after 8 weeks of treatment
• Signs of a severe allergic reaction or infection
• Unusual worsening redness, pain, or swelling, or other signs of skin infection (pus, warmth, fever)
• Any vision changes if using medication near your eyes

Have more questions?

Contact your Zest care team by texting (865)-426-1746 or sending a chat message from your portal. You’ve got this, and we’ve got you. Together, let’s work toward relief and clear skin!