The therapeutic efficacy of a systemic agent can not only be enhanced by dose escalation but also by combination with topical treatment. Choosing the right vehicle is especially important in scalp psoriasis.
In many patients, psoriasis shows a relapsing course with remissions and exacerbations and is sometimes refractory to treatment. In case of systemic treatment, escalating dosage, shortening injection intervals, or switching therapy is not the only way to enhance therapeutic efficacy. As Prof. Peter van de Kerkhof (Radboud University Medical Centre, the Netherlands) pointed out in his lecture, adding topical therapy to systemic agents might be a smart way to improve efficacy without safety concerns . Today, combination therapies have shown improved efficacy compared with monotherapy with systemic agents . Until today, topical corticosteroids play a key role in the treatment of psoriasis, especially for localised disease, due to their anti-inflammatory, antiproliferative, immunosuppressive, and vasoconstrictive effects.
Topical corticosteroid therapy in combination with etanercept has shown improved efficacy without any increased safety concerns. Another recommended topical combination is calcipotriol plus betamethasone dipropionate. Together with adalimumab, this combination showed superior efficacy compared with adalimumab monotherapy at 4 weeks. Moreover, patients treated with conventional disease-modifying drugs may benefit from the addition of topical agents. By adding calcipotriol to methotrexate, a lower cumulative dose of the latter could be observed, and there was an increased time to relapse after its discontinuation. Another study showed that the clinical response was enhanced by adding calcipotriol plus betamethasone dipropionate ointment to low-dose cyclosporin. Topical calcipotriol treatment has also been shown to improve the efficacy of acitretin.
Taken together, topical corticosteroids in psoriasis are still strong options in the management of the disease. Of note, the optimal vehicle choice is often the one the patient is most likely to use . For example, the scalp can successfully be treated with solutions, foam, or spray, whereas creams are preferred for glabrous skin. In every case, patient preference should be considered when selecting the most appropriate vehicle.
- van de Kerkhof P. Corticosteroids in the topical treatment of psoriasis. B15_1, SPIN 2022 Congress, 06–08 July, Paris, France.
- Elmets CA, et al. J Am Acad Dermatol. 2021;84:432-70.
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Table of Contents: SPIN 2022
Letter from the Editor
SPIN 2022 Highlights Podcast
IMIDs in Adults and Children: New Developments
Therapies for atopic dermatitis: still moving forward
Children with AD: high risk of bacterial infections in carriers of a filaggrin gene variant
Men on biologics report fewer adverse events than women
Conceptual framework of adverse drug reactions may improve treatment of patients with IMIDs
Psoriasis: The Beat Goes On
Systemic treatment for psoriasis: what is on the horizon?
Topical therapy in psoriasis: an important partner in combination therapy
GPP flares: pronounced undertreatment is common
IL-17A/F inhibitor bimekizumab shows higher response and maintenance rates compared with secukinumab
Paediatric psoriasis: ixekizumab beneficial in difficult-to-treat areas
Psoriasis patients see great benefit in achieving complete skin clearance
The Future Is Bright for Vitiligo
Predilection sites for skin signs of vitiligo disease activity determined
Where Are We Now in Hidradenitis Suppurativa
IHS4 better suited as an outcome measure in HS trials?
New treatments for HS: IL-17 inhibitors next in practice?
New Treatment Options in Alopecia Areata
Alopecia areata: light at the end of the tunnel
Alopecia areata pathogenesis: known genetic background, unknown environmental triggers
Best of the Posters
Psoriasis treatment: no elevation of MACE and VTE on deucravacitinib
Comorbid anxiety and depression may benefit from psoriasis treatment with certolizumab
Dose tapering in psoriasis is associated with a low relapse rate
Psoriasis associated with increased duodenum inflammation
IL-17 blocker: effective and safe in patients with comorbidities
IL-17A and IL-17F blockade remarkably effective in psoriasis