Novel developments in topical psoriasis therapy

Topical therapy remains a mainstay of psoriasis management, especially in mild psoriasis. Today, proactive therapy is not only recommended in atopic dermatitis but also in psoriasis where it has demonstrated to prolong remission.

“Most patients with psoriasis have mild disease, which might be treated with topical agents,” said Prof. April Armstrong (University of Southern California Keck School of Medicine, CA, USA). Topical steroids have been the workhorse of treating psoriasis for a long time. Today, new and more active topical treatments are on the horizon.

The topical small molecule tapinarof is a modulator of the aryl hydrocarbon receptor, which is important for skin homeostasis. It lowers Th17 cytokines and oxidative stress and enables skin barrier normalisation. In 2 pivotal phase 3 trials (PSOARING 1 [NCT03956355] and PSOARING 2 [NCT03983980]), 35.4% and 40.2% of participants, respectively, treated with the 1% tapinarof cream once daily achieved clear or almost clear skin in the Physician Global Assessment (PGA) at week 12 [2]. Another interesting agent is the PDE4 inhibitor roflumilast. As Prof. Armstrong explained, the mode of action is similar to apremilast but the agent is a lot more potent.

Similar to atopic dermatitis, proactive treatment is now also recommended in psoriasis. “Formerly, we treated reactively, until patients were clear. Then we stopped treatment and would start again when symptoms arose,” Prof. Armstrong explained. However, psoriasis typically sees regions that flare and are quiescent in between flares. “So, for these areas, consider 2-weekly treatments because this can prevent flares in these areas,” Prof. Armstrong recommended. The efficacy of such proactive treatment has been shown in the PSO-LONG trial (NCT02899962). In this trial, 1-year proactive management with calcipotriol 50 µg/g and betamethasone dipropionate 0.5 mg/g foam demonstrated superior efficacy versus reactive management: Patients in the proactive group had an additional 41 days in remission compared with the reactive group over 1 year (P<0.001) [3].

 

1. 
   
   1. Armstrong A. New Developments in Psoriasis Comorbidity and COVID19. S016, AAD 2022 Annual Meeting, 25–29 March, Boston, MA, USA.
   2. Lebwohl MG, et al. N Engl J Med 2021;385:2219–2229.
   3. Lebwohl M, et al. J Am Acad Dermatol 2021;84:1269–1277.

 

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Posted on 17 May 202229 February 2024