Biologics and systemic therapies command much of the spotlight for treating psoriasis, but topical therapy remains an effective option for many psoriasis patients, according to Dr. Linda Stein Gold.
In fact, up to 80% of psoriasis patients can be adequately treated with topical therapy (N. Engl. J. Med. 2005;352:1899-912), said Dr. Stein Gold at the Skin Disease Education Foundation’s (SDEF’s) annual Las Vegas dermatology seminar.
She offered several principles to help clinicians make the most of topical therapies by troubleshooting potential problems.
• Check the amount. One gram of most topical psoriasis products covers 4% of body surface area per application, so a 60-gram tube should treat 4% of body surface area for a month, said Dr. Stein Gold, citing guidelines developed by Dr. Alan Menter and his colleagues and approved by the American Academy of Dermatology in 2009.
• Don’t miss corticosteroid allergies. "We are missing this," said Dr. Stein Gold, director of dermatology research at Henry Ford Hospital in Detroit. Suspect a possible allergy if a patient returns with a worsening rash after using hydrocortisone, for example. Data have shown that between 0.2% and 5% of all dermatitis patients have a steroid allergy. "Allergy to the active molecule or to the vehicle should be suspected in all patients who don’t respond as expected to topical steroids," she noted.
• Visit (or revisit) vitamin D. Another plus for topical therapy is the usefulness of topical vitamin D for tricky areas, such as the forehead, armpit, groin, and the area behind the ears. Data from a randomized trial of 75 patients found calcitriol ointment to be significantly more effective against target lesions and better tolerated by patients than calcipotriene ointment (Br. J. Dermatol. 2003;148:326-33).
• Don’t forget coal tar. Simple, but effective, coal tar is a proven safe topical psoriasis treatment and is available in several vehicles, including solution and foam. Data from a study of more than 13,000 patients with psoriasis and eczema found that coal tar was safe, and that it did not increase the risk for skin cancer (J. Invest. Dermatol. 2010;130:953-61).
The future of topical psoriasis therapy is not static, said Dr. Stein Gold. New molecules – notably topical Janus kinase inhibitors and phosphodiesterase-4 inhibitors – are currently being explored in clinical trials.
Dr. Stein Gold disclosed relationships with Leo, Medicis, and other companies. SDEF and this news organization are owned by Frontline Medical Communications.