Salicylic Acid 6% in an Ammonium Lactate Emollient Foam Vehicle in the Treatment of Mild-to-Moderate Scalp Psoriasis

March 2011 | Volume 10 | Issue 3 | Original Article | 270 | Copyright © March 2011

Leon Kircik MD

Physicians Skin Care, Louisville, KY

Abstract
Scalp psoriasis is a common life-altering skin condition causing a great deal of distress. It significantly affects quality of life and is difficult to manage. Treatment can provide variable results, often impacting patient compliance with therapy. Salicylic acid is used as adjunctive therapy to other topical treatments because of its marked keratolytic effect. Its effectiveness as a monotherapy is not fully understood. An emollient foam formulation of 6% salicylic acid (Salkera) in an ammonium lactate vehicle has recently become available. Efficacy, tolerability and patient acceptability of salicylic acid 6% emollient foam were assessed in an open-label pilot study of 10 subjects with scalp psoriasis. All psoriasis severity parameters were reduced with a significant decrease in Psoriasis Scalp Severity Index (PSSI) score from 15.3 to 3.0 after four weeks of monotherapy (P<0.001). Sixty percent of subjects were either "completely cleared" or “almost cleared” of their psoriasis. No adverse events (AEs) were reported. All signs and symptom tolerability measures demonstrated statistically significant score decreases with the exception of oiliness severity and patient-reported burning tolerability. Salicylic acid 6% emollient foam provides a useful option in the treatment of psoriasis that is highly effective, well tolerated and acceptable to patients.

J Drugs Dermatol. 2011;10(3):270-273.

INTRODUCTION

Psoriasis is a chronic inflammatory skin condition characterized by exacerbations and remissions afflicting 1-3 percent of the population.1-3 Forty to fifty percent of patients (in one survey as many as 79%) have scalp involvement ranging from very mild to very severe with thick, crusted plaques covering the entire scalp.4-7 The scalp is one of the first sites affected, more frequently with psoriasis duration8 and patients often report psoriasis elsewhere.9
Scalp psoriasis is itchy and uncomfortable; shedding scales lead to embarrassment and distress.10 Hair-thinning in longstanding cases causes further distress.11
It can be particularly challenging to treat. The thick plaques present penetration barriers and hair concealing the scalp skin makes application difficult. Nearby sensitive facial skin can also limit use of potentially irritating topicals or high-potency topical steroids. Treatment can be unpleasant,12 generally produces indifferent results, along with only partial control and high relapse rates.11
Patient adherence is often poor. Medications are greasy, sticky, odorous, may cause hair color changes, can be difficult to apply, and require frequent application. Patients prefer vehicles that leave fewer residues, such as foams, to traditional creams and ointment. Preferences can impact compliance13 and treatments may negatively affect patients' quality of life.14
Topical corticosteroids are the treatment choice for the majority of psoriasis patients, particularly those with limited disease. Keratolytic agents (such as salicylic acid) and non-medicated