Concerns With Long-Term Use of Standard Topical Treatment in Psoriasis

Neal Bhatia, MD: Patients have many concerns about the long-term use of steroids, and topical steroids unopposed, as opposed to in combination with calcipotriene or tazarotene, hopefully are going to be something we see less and less of. In fact, in dermatology, we tend to see more of those patients referred to us on topical steroids alone. Most dermatologists are cognizant of the impact of steroid atrophy and tachyphylaxis absorption, HPA [hypothalamic-pituitary-adrenal] axis suppression, and some of the other consequences. Even though I think our biggest concern is the fatigue that patients get from overuse of steroids without the improvement in their psoriasis.

I think the flip side to the equation is thinking in terms of what is the long-term benefit of steroids when we have now some other agents that can do a little more to the process of what makes psoriasis, rather than just cleaning up the inflammation we see in front of us. The nice thing about topical steroids is the sprint effect, things work very quickly. The anti-itch benefits that patients get are also a consequence of the anti-inflammatory impact. I think even more so with the long-term safety of combinations of calcipotriene and tazarotene, we do have good options for using these medications. However, I also see where roflumilast cream and some of the other agents, such as tapinarof and newer agents on the market, have the potential to take a hold of the marketplace as well as their use as a cream. This is where ointment and lotions and foams may not have been the right vehicle for the right place and may have a few other components of concern for patients who have tried treatments and just don’t have the bandwidth to continue to experiment.

We’re at a very exciting time with the development of some of these new molecules, new agents for the topical treatment of psoriasis. It’s important to remember how much control patients want with using topical agents, how they still want to put something on their skin and feel like they’re in control of their disease. I think some of these newer agents that are steroid-free, and at least can be used in conjunction with topical steroids or with systemic agents, give us an opportunity for long-term benefits for these patients from what we’ve seen in clinical trials as well as patient experience so far. Obviously, there are no head-to-head trials comparing any of these agents, but at the same time, we have a lot of opportunity to take our experience and say, “I’ve seen some good benefits with this. Let’s talk to the next patient about what we think is the best outcome for them based on the opportunity that these topicals provide us.”

Transcript Edited for Clarity