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Topical Antipsoriatic Treatments in 2007
L. Kircik, MD1, L. Guenther, MD, FRCPC2, D. R. Thomas, MD, FRCPC3
The number of patients with psoriasis is increasing, while the number of medical dermatologists is shrinking. There are more than 1 million psoriasis patients in Canada, with 620,000 visits to a health care professional in 2006 for treatment of this condition. Approximately 35% of these visits were with dermatologists; the remainder was handled primarily by family practitioners.
There are a wide range of definitions of disease severity for psoriasis. In light of the various measures that are currently available, patients can be separated into two categories: those treated with local (topical) therapy and those treated with systemic therapy. This article will deal with topical therapy.
Topical Treatment Options and the Treatment Triangle
Topical medications, either as monotherapy or in combination, are the most commonly prescribed treatments by both dermatologists and family practitioners. The treatment triangle brings together evidence-based medicine, patient preference, and the physician’s expertise in order to determine the most appropriate treatment approach. Given the increasingly limited access to dermatologists, adequate education on all available treatment options must be provided to family practitioners in order for them to adequately manage the psoriatic population in Canada.
Commonly Used Topical Antipsoriatic Therapies
The use of emollients improves the skin barrier function by restoring hydration and forming a protective layer that guards against infection and other irritants. Additional benefits include:
Corticosteroids are potent compounds widely used for their anti-inflammatory, immunosuppressive and antiproliferative effects.
Tar slows the proliferation of skin cells and reduces inflammation, itching and scaling. While tar compounds are very effective for treating scalp psoriasis, they have several limitations:
Anthralin reduces the rapid acceleration of skin growth, as seen in psoriasis.
Use of calcipotriol in combination with steroids enhances efficacy. However, compounding should be used with caution. Ad hoc mixtures of calcipotriol plus steroids (including betamethasone dipropionate and betamethasone valerate) have been shown to be unstable. The valerate steroid activity disappeared within 24 hours, while the dipropionate steroid activity was more than one-third depleted after only 4 weeks.
Calcipotriol plus Betamethasone Dipropionate
Topical Calcineurin Inhibitors
Noncompliance and Nonadherence
Noncompliance or nonadherence to treatment can influence outcomes in all disease states. They unquestionably lower response to treatment, and this is of particular concern with topical medications. When the illness has the severity potential of psoriasis, physicians need to find treatment options that best suit each patient.
There is no reliable method to ensure or improve compliance in patients with psoriasis. Some clinical strategies to promote compliance include:
Advancements in topical antipsoriatic therapies have provided safer and more effective treatment options, especially when used in combination. Consequently, much research is underway to investigate novel treatment combinations for psoriasis in the hope that it will provide further enhancements in efficacy that will lead to improved patient compliance.
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Last modified: Thursday, 20-Feb-2014 17:05:45 MST