increased skin hydration/water content) was observed, and an earlier reduction of lesional transepidermal water loss was achieved in the treatment group versus the control group. Subsequently, T1 patients were randomized for another year to 2 groups: the LA-Cer group (T2) maintained the use of moisturizer, and the control group (C2) discontinued the use of the moisturizer. Less relapse and rebound were observed in the T2 group than in the C2 group at year 1. Capacitance, lesional transepidermal water loss, and PASI remained stable in the T2 group.
Statement 8
The management of scalp psoriasis in patients with skin of color requires consideration of hair texture, styling practices, and washing frequency (which in turn, may be influenced by cultural, religious, or social factors).
Although scalp psoriasis occurs in all ethnic groups, greater severity may be seen in African American patients.4,5 Cultural/ traditional therapies may be used before patients seek dermatological consultation. Factors such as hair texture, styling practices, and washing frequency can affect the severity and should be considered in the selection of topical therapy. The treatment regimen should be compatible with the patient's hair care practices. Less frequent hair washing (typically ranging from once per week to once per month, depending on the style) is common in women of African descent. Daily hair washing is very time-consuming for most women of African descent due to common styling practices.5 Also, most prescription shampoos are often associated with increased hair dryness and breakage in patients with SOC who have textured hair. Ketoconazole shampoo, although effective, can be particularly drying in textured hair. Clinicians should recommend adjunctive use of a hydrating conditioner to help ameliorate the drying effects of ketoconazole shampoo when prescribing it for their patients with SOC who have textured hair.
Statement 9
Some moisturizers have been shown to have direct biological functions, including barrier repair.
Patients may benefit from emollients as an adjuvant treatment with psoriasis to restore barrier function and reduce transepidermal water loss, desquamation, and pruritus.3,9 Guidelines recommend the use of emollients in combination with topical corticosteroids to help reduce itching, desquamation, and body surface area (BSA) involvement and prevent relapse of psoriasis following discontinuation of topical corticosteroids.9
In a multicenter, randomized, controlled trial of 178 patients with psoriasis, treatment with a linoleic acid-ceramidecontaining moisturizer in combination with mometasone furoate for 4 weeks resulted in decreased rates of relapse after topical glucocorticoid administration.32 Maintenance therapy with linoleic acid-ceramide-containing moisturizer achieved continuous improvement in BSA involvement, PASI score, investigators' skin dryness and desquamation assessment, Physician Global Assessment of Psoriasis score, and patient QoL.
Statement 10
Patients with psoriasis may underuse skin care as a tool in the management of their disease. Topical moisturizers in psoriasis have been reported to increase hydration, decrease desquamation, improve the overall appearance of the skin, improve PASI-50 in conjunction with topical steroids, and delay relapse.
Clinicians and patients would benefit from increased awareness of the importance of skin care in psoriasis. Early initiation and maintenance of well-tolerated treatment regimens and the use of carefully selected adjunctive skin care are recommended approaches to increase patient compliance and outcomes.
Moisturization has been demonstrated in small psoriasis studies to help restore the skin barrier, impact gene expression, and cytokine profile, and even alter the skin microbiome.30,32 Patients with mild plaque psoriasis, seborrheic dermatitis, sebopsoriasis, or persistent post-psoriasis sequelae may experience some symptom improvement even without prescription therapy when compliant with a rigorous moisturization regimen.
In a study of psoriasis relapse prevention with ceramide-based adjunctive skin care, 2 cohorts of patients with psoriasis (n=30 and n=60) were treated topically with a proprietary emollient ceramide-based cream applied twice daily to one forearm.33 The same sites on the contralateral arm served as the untreated control. Epidermal function on both arms was assessed prior to and at the end of the trials. A delayed relapse on the treated arm was seen in 54.5% of patients in the first cohort (20 days of use) and 71% of patients in the second cohort (30 days of use). The time to relapse of psoriasis correlated with the severity of baseline epidermal barrier dysfunction. These results suggest that improvements in epidermal function with topical emollients may prevent or attenuate psoriasis flares.
Statement 8
The management of scalp psoriasis in patients with skin of color requires consideration of hair texture, styling practices, and washing frequency (which in turn, may be influenced by cultural, religious, or social factors).
Although scalp psoriasis occurs in all ethnic groups, greater severity may be seen in African American patients.4,5 Cultural/ traditional therapies may be used before patients seek dermatological consultation. Factors such as hair texture, styling practices, and washing frequency can affect the severity and should be considered in the selection of topical therapy. The treatment regimen should be compatible with the patient's hair care practices. Less frequent hair washing (typically ranging from once per week to once per month, depending on the style) is common in women of African descent. Daily hair washing is very time-consuming for most women of African descent due to common styling practices.5 Also, most prescription shampoos are often associated with increased hair dryness and breakage in patients with SOC who have textured hair. Ketoconazole shampoo, although effective, can be particularly drying in textured hair. Clinicians should recommend adjunctive use of a hydrating conditioner to help ameliorate the drying effects of ketoconazole shampoo when prescribing it for their patients with SOC who have textured hair.
Statement 9
Some moisturizers have been shown to have direct biological functions, including barrier repair.
Patients may benefit from emollients as an adjuvant treatment with psoriasis to restore barrier function and reduce transepidermal water loss, desquamation, and pruritus.3,9 Guidelines recommend the use of emollients in combination with topical corticosteroids to help reduce itching, desquamation, and body surface area (BSA) involvement and prevent relapse of psoriasis following discontinuation of topical corticosteroids.9
In a multicenter, randomized, controlled trial of 178 patients with psoriasis, treatment with a linoleic acid-ceramidecontaining moisturizer in combination with mometasone furoate for 4 weeks resulted in decreased rates of relapse after topical glucocorticoid administration.32 Maintenance therapy with linoleic acid-ceramide-containing moisturizer achieved continuous improvement in BSA involvement, PASI score, investigators' skin dryness and desquamation assessment, Physician Global Assessment of Psoriasis score, and patient QoL.
Statement 10
Patients with psoriasis may underuse skin care as a tool in the management of their disease. Topical moisturizers in psoriasis have been reported to increase hydration, decrease desquamation, improve the overall appearance of the skin, improve PASI-50 in conjunction with topical steroids, and delay relapse.
Clinicians and patients would benefit from increased awareness of the importance of skin care in psoriasis. Early initiation and maintenance of well-tolerated treatment regimens and the use of carefully selected adjunctive skin care are recommended approaches to increase patient compliance and outcomes.
Moisturization has been demonstrated in small psoriasis studies to help restore the skin barrier, impact gene expression, and cytokine profile, and even alter the skin microbiome.30,32 Patients with mild plaque psoriasis, seborrheic dermatitis, sebopsoriasis, or persistent post-psoriasis sequelae may experience some symptom improvement even without prescription therapy when compliant with a rigorous moisturization regimen.
In a study of psoriasis relapse prevention with ceramide-based adjunctive skin care, 2 cohorts of patients with psoriasis (n=30 and n=60) were treated topically with a proprietary emollient ceramide-based cream applied twice daily to one forearm.33 The same sites on the contralateral arm served as the untreated control. Epidermal function on both arms was assessed prior to and at the end of the trials. A delayed relapse on the treated arm was seen in 54.5% of patients in the first cohort (20 days of use) and 71% of patients in the second cohort (30 days of use). The time to relapse of psoriasis correlated with the severity of baseline epidermal barrier dysfunction. These results suggest that improvements in epidermal function with topical emollients may prevent or attenuate psoriasis flares.
LIMITATIIONS
A detailed discussion on the myriad of factors that contribute to racial disparities in psoriasis outcomes is beyond the scope of this review. These factors described elsewhere in the literature include genetics, environmental influences, cultural variations, and social determinants of health.4,22,34,35 However, studies on racial differences in skin properties have yielded inconclusive results.26 Despite the widespread availability of over-the-counter skincare products, robust evidence-based studies on skin care for patients with psoriasis who have SOC are lacking. The
