INTRODUCTION
Hyperkeratotic psoriatic plaques are associated with treatment difficulty and enhanced disease burden. For instance, patients with elevated plaques are less likely to achieve skin clearance with topical corticosteroids (TCSs) than patients with less plaque elevation.1 Additionally, by obstructing light penetration, severe scaling may limit response to phototherapy.2 Furthermore, patients with moderate-to-severe scaling experience poorer quality of life than patients without scaling.3
Because of their rapid action and safety when used in accord- ance with current guidelines, TCSs are a mainstay of psoriasis treatment.4,5 Treatment with an ultra-high potency TCS (eg, halobetasol propionate [HP, potent-to-superpotent]) is recommended for thick plaques.5 The retinoid tazarotene (TAZ) can supplement and reduce TCS use and mitigate the risk of steroid-associated adverse events, although pruritis and irritation may occur with TAZ monotherapy.5-7 Additionally, TAZ causes a reduction of inflammation and normalization of keratinocyte differentiation and proliferation, which may contribute to resolving hyperkeratosis.5,8 Fixed-combination halobetasol propionate (0.01%) and tazarotene (0.045%) lotion (HP/TAZ) leverages the rapid onset of TCS action and immunogenetic mechanisms of TAZ to reduce keratinocyte proliferation while also mitigating TCS- and TAZ-associated adverse event risk.9 The addition of TAZ to HP increases TCS effectiveness, minimizes steroid exposure, and optimizes maintenance of psoriasis remission.5,9,10 Further, the complementary mechanisms of HP and TAZ, including anti-inflammatory action and reduction in keratinocyte hyperproliferation, suggest that HP/TAZ may ameliorate hyperkeratosis.9
Hyperkeratotic plaques require an efficacious and well-tolerated therapy that reduces scaling and elevation. In the authors' clinical experience, HP/TAZ shows particular efficacy for hyperkeratotic plaques; however, clinical data supporting this observation are needed. To investigate the utility of HP/TAZ,
Because of their rapid action and safety when used in accord- ance with current guidelines, TCSs are a mainstay of psoriasis treatment.4,5 Treatment with an ultra-high potency TCS (eg, halobetasol propionate [HP, potent-to-superpotent]) is recommended for thick plaques.5 The retinoid tazarotene (TAZ) can supplement and reduce TCS use and mitigate the risk of steroid-associated adverse events, although pruritis and irritation may occur with TAZ monotherapy.5-7 Additionally, TAZ causes a reduction of inflammation and normalization of keratinocyte differentiation and proliferation, which may contribute to resolving hyperkeratosis.5,8 Fixed-combination halobetasol propionate (0.01%) and tazarotene (0.045%) lotion (HP/TAZ) leverages the rapid onset of TCS action and immunogenetic mechanisms of TAZ to reduce keratinocyte proliferation while also mitigating TCS- and TAZ-associated adverse event risk.9 The addition of TAZ to HP increases TCS effectiveness, minimizes steroid exposure, and optimizes maintenance of psoriasis remission.5,9,10 Further, the complementary mechanisms of HP and TAZ, including anti-inflammatory action and reduction in keratinocyte hyperproliferation, suggest that HP/TAZ may ameliorate hyperkeratosis.9
Hyperkeratotic plaques require an efficacious and well-tolerated therapy that reduces scaling and elevation. In the authors' clinical experience, HP/TAZ shows particular efficacy for hyperkeratotic plaques; however, clinical data supporting this observation are needed. To investigate the utility of HP/TAZ,
