Topical Treatment Updates in Psoriasis
Next Steps in Derm and the Journal of Drugs in Dermatology, in partnership with the Dermatology Education Foundation (DEF) and Physicians Resources, interviewed
Linda Stein Gold, MD, FAAD, director of dermatology, and clinical research and division head of dermatology at Henry Ford Health System in Detroit and West Bloomfield, MI. Dr. Stein Gold reminds clinicians that topical therapy is still the cornerstone of psoriasis treatment, and great topical treatment options are available. Remember: Combination therapy is generally better than monotherapy. Watch as Dr. Stein Gold shares some good fixed combinations, including some newly FDA-approved options.
Dr. Linda Stein Gold lectured on this and other topics at the recent DERM2022 NP/PA CME conference held July 28-31, 2022.
Further Reading
If you want to read more about topical treatments for psoriasis, check out the following articles published in the Journal of Drugs in Dermatology:
Discordance between patient and clinician treatment goals and expectations can present a challenge to implementation of effective therapeutic plans. Because topical treatments are commonly used for plaque psoriasis, both as monotherapy and adjuncts to other treatment modalities, providers need to understand the concerns of patients with psoriasis regarding use of topical products. Psoriasis is a complex and chronic disease with treatment needs that may change over time, influencing patient treatment goals and expectations of efficacy. When these expectations are not met and patient concerns are unaddressed, dissatisfaction may lead to nonadherence, which in turn can prevent patients from achieving relief from the signs and symptoms of psoriasis that affect their quality of life.
Here, we detail how current topical treatments meet patient expectations and needs, with particular attention given to combination regimens using corticosteroids. This review shows that once-daily application of halobetasol propionate (0.01%) and tazarotene (0.045%) lotion (HP/TAZ) not only has a rapid onset of treatment effect and proven efficacy, but also has a remittive effect. In addition, HP/TAZ has a favorable safety profile, with low rates of irritation and local skin reactions in clinical studies. The dual mechanisms of action related to 2 active ingredients, once-daily use, and the favorable clinical findings suggest that HP/TAZ may address patient concerns and promote treatment adherence.
Even in light of significant recent therapeutic advancements, many patients with psoriasis will use a combination of treatments at some point in the disease course. Despite the frequency with which combinations are used in clinical practice, there are few large-scale, randomized controlled trials investigating the use of various combination therapies in psoriasis. Twice-weekly maintenance application of topical Cal/BD aerosolized foam has recently been shown to prolong time to remission and is associated with fewer relapses in patients initially treated with standard dosing of the formulation. Data from a small number of pilot studies suggest potential benefits from the combined used topical Cal/BD foam with oral apremilast.
This pilot study assesses the effect of twice-weekly maintenance doses of Cal/BD foam after 4 weeks of standard once-daily treatment in combination with apremilast. The combination of apremilast plus Cal/BD achieved the primary endpoint, with 95% of subjects rated clear or almost clear on PGA at week 4. Subject’s global assessment scores showed similar improvement to PGA scores at week 4 (47% of subjects clear or almost clear). Ten subjects (53%) achieved PASI 75 at week 4, and 12 (63%) achieved PASI 75 at week 16.Maintenance dosing of Cal/BD foam in combination with apremilast is safe and effective for the management of moderate psoriasis.
