The Clinical Relevance and Therapeutic Benefit of Established Active Ingredients Incorporated into Advanced Foam Vehicles: Vehicle Characteristics Can Influence and Improve Patient Outcomes

February 2019 | Volume 18 | Issue 2 | Supplement Individual Articles | 100 | Copyright © February 2019

James Q. Del Rosso DO,Ma Leon Kircik MD,b Joshua Zeichner MD,c Linda Stein Gold MDd

aJDR Dermatology Research/Thomas Dermatology, Las Vegas, NV; Touro University, Henderson, NV bIcahn School of Medicine at Mount Sinai, New York, NY cIcahn School of Medicine at Mount Sinai, New York, NY dHenry Ford Hospital, Detroit, MI

Take Home Observations and Concluding Remarks
  • It is important that CalcipF and TazF be stored appropriately away from excessive heat. As the propellant in these foams is flammable, the patient is to avoid proximity to flames, fire, and smoking during dispensing and application of the foam.24,25 
  • Foam formulations were first used as vehicles for TCS for disease states that often affected large body surface areas. Additionally, some foams were associated with skin dryness and irritation due to their hydroethanolic base. As a result, the positioning of foam vehicles in the minds of clinicians has unfortunately led to use limited to widespread disease due to spreadability, and/or avoidance of facial use due to concerns about irritation or lack of familiarity with proper methods of application. The favorable tolerability and delivery properties of the aqueous foams provides greater adaptability for localized or widespread use, including facial application.
  • To improve facial application of a foam vehicle and avoid waste, it is suggested that a small amount be applied to the top of the foam cannister cap. The lead author recommends that the tip of the finger be used to transfer the foam by spot application to six points on the face: right forehead, left forehead, right mid cheek, left mid cheek, chin, and lower nose dorsum. The fingers can then be used to confluently connect the spots of application by gentle circular motion to provide even and diffuse facial application, with avoidance of the eyelids and lips.
  • The risk of calcipotriene use during pregnancy is not fully established and should be used only if the potential benefit justifies the potential risk.24 
  • Patients should avoid exposure to natural sunlight, artificial ultraviolet (UV) light, or application prior to phototherapy when using CaciplF due to instability and breakdown of calcipotriene upon exposure to UV light.24,42 Calcioptriene may also be broken down and inactivated when applied concurrently with acidic pH products such as salicyclic acid, lactic acid, and some TCS.43 
  • The risk of clinically relevant hypercalcemia is very low with topical calcipotriene use.34,35 
  • Product labeling with calcipotriene suggests avoidance of use in patients with known hypercalcemia.24,28-30 
  • Topical tazarotene in contraindicated in pregnancy. Females of child-bearing potential should be instructed to use adequate birth control measures when using tazarotene.25,39-41 
  • Patients should be instructed regarding potential for visible
  • and/or symptomatic ASRs when using a topical retinoid for AV, including TazF. Gentle skin care including moisturizer use may be needed to ameliorate local skin reactions.39-41 
  • Space limitations preclude the ability to cover all of information in product labeling and pivotal study publications. It is recommended that the reader review the package inserts for CalcipF and TazF, including storage recommendations, application instructions, patient information, and important safety information.24,25 

    Drs. Del Rosso, Kircik, and Stein Gold have served as advisors and speakers for Mayne Pharma. Dr. Zeichner has served as a consultant for Mayne Pharma.


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    James Q. Del Rosso DO