Topical Therapies for Psoriasis: Improving Management Strategies and Patient Adherence

Abstract

Psoriasis is a chronic disease that has a substantial effect on quality of life of patients and often needs long-term treatment. Topical treatments for psoriasis include corticosteroids, vitamin D derivatives, tazarotene, anthralin, tacrolimus, pimecrolimus, and newer formulations of tar. Although many of these treatments are effective, they must be prescribed appropriately and used consistently for a period of weeks to months before clinical evidence of improvement can be seen and patients perceive that the treatment is working. As such, medication dosage/schedule, choice of vehicle, and especially patient adherence to medication are key factors for a treatment to be effective. Addressing patient preferences about treatments and concerns about treatment-related toxicities and managing their expectations represent additional aspects of patient care. Therapies such as calcipotriene and betamethasone dipropionate (Cal/BD) fixed combination foam and new drugs and vehicles continuously enhance the treatment landscape for psoriasis. Because adherence to topical treatment can be a major difficulty, keeping the treatment regimen simple and using new and sophisticated treatment vehicles that are acceptable to patients can likely improve treatment outcomes.

PSO-LONG: Design of a Novel, 12-Month Clinical Trial of Topical, Proactive Maintenance with Twice-Weekly Cal/BD Foam in Psoriasis

“…Estimates suggest that psoriasis affects as many as 7.5 million people in the USA and more than 125 million people worldwide [ 4 – 6 ]. Within this population, approximately 80% of patients have mild-to-moderate and/or localized disease that can be successfully treated with topical medications; approximately 20% of patients have moderate-to-severe disease that often requires treatment with systemic medications [ 7 – 9 ]. Despite the numerous treatment options that are currently available for psoriasis, more than half of patients report being dissatisfied with their treatment, and a significant number of patients continue to have residual plaques that require long-term maintenance therapy [ 7 ].…”

“…Currently available topical agents for mild-to-moderate psoriasis include corticosteroids, vitamin D analogues, tazarotene, anthralin, calcineurin inhibitors, and tar [ 8 , 9 ]. Potent biologic therapies have been developed for use in patients with moderate-to-severe psoriasis [ 10 ]; nevertheless, topical therapies continue to be an effective means to complement systemic therapies in this hard-to-treat population [ 8 , 9 ]. In fact, almost all patients utilizing systemic therapy continue the use of topical therapies, which highlights the importance of topicals for effective management of chronic psoriasis.…”

Topical therapy of psoriasis

“…This strategy of combining topical therapy with systemic and phototherapy results in additional and immediate symptom relief, reduction in the dose of systemic medications, and better psychological comfort to patients. [ 2 3 4 5 6 ]…”

“…The various topical therapeutic agents used in psoriasis include emollients, keratolytic agents such as salicylic acid, coal tar, dithranol, corticosteroids, Vitamin D analogs, retinoids, and immunomodulators such as tacrolimus and pimecrolimus. [ 1 2 3 4 5 6 ] Recommendations based on evidence-based data suggest class I corticosteroids, Vitamin D analogs, tazarotene, and combinations of either corticosteroids and Vitamin D analog or corticosteroids and tazarotene as class A rank drugs (evidence based on large, prospective, double-blind studies and consistent and good-quality patient-oriented evidence) that are statistically superior to other topical therapies. [ 2 5 ] Other agents that have been tried in topical therapy of psoriasis include 5-fluorouracil, ascomycin derivative, methotrexate, and leukotriene inhibitors.…”

“…The investigational topical agents for psoriasis target the small molecules that modulate proinflammatory cytokines and selectively inhibit signaling pathways which include inhibitors of phosphodiesterase 4, integrin, Janus kinase (JAK) 1/JAK2 (ruxolitinib, tofacitinib), and tyrosine kinase. [ 2 10 ] AN2728, a boron-based phosphodiesterase 4 inhibitor with anti-inflammatory property, has been administered topically in phase 2 studies to patients with psoriasis. [ 11 ] JAK inhibitors, being small molecules, can easily penetrate the epidermal barrier and hence are used in topical formulations.…”