The number of treatment options
available to those with psoriasis has nearly doubled in the past few years.
And the number of options is continuing to increase as dermatologists study
combinations of new therapies and previously available treatments. Some of
these combinations are improving patients' quality of life as they prove to be
more effective and offer longer periods of remission.
Speaking today at the American Academy of Dermatology's 2001 Annual
Meeting in Washington, D.C., dermatologist Mark Lebwohl, MD, Professor and
Chairman, Department of Dermatology, Mount Sinai School of Medicine, New York,
talked about new treatments for psoriasis, including those still in
development, as well as the possibility of mixing treatments for greater
"Psoriasis is chronic and unpredictable, but these new treatments and
combinations offer a greater chance of remission with less side effects --
something that is very important to individuals with psoriasis who have to
find a long-term treatment that best fits their lifestyle," said Dr. Lebwohl.
Psoriasis is a recurring, noncontagious skin disorder that is
characterized by raised, thickened patches of red skin covered with
silvery-white scales. Psoriasis can range in severity and affect any part of
the body, including the nails and scalp. It is estimated that over 7 million
Americans have psoriasis, with more than 150,000 new cases reported each year.
New Psoriasis Treatments
Clobetasol propionate, one of the most effective topical corticosteroids
for the treatment of psoriasis, has recently been approved as a foam
specifically for the treatment of scalp psoriasis. The foam penetrates the
skin easily, enhancing the effectiveness of the treatment. "Clobetasol foam
is easy to use, less messy than other topical formulations, and therefore
readily accepted by patients for the treatment of scalp psoriasis as well as
psoriasis at other body sites," said Dr. Lebwohl.
Tacrolimus ointment has recently been approved for the treatment of atopic
dermatitis and does show promise for the treatment of psoriasis on the face
and other areas prone to sensitivity and side effects when treated with other
topical agents. However, the treatment does not seem effective for the
treatment of thick plaque psoriasis.
New Combinations of Treatment Options
Calcipotriene, a topical vitamin D synthetic that has been available for
several years, has recently been shown to have positive interactions with
other psoriasis treatments. In particular, calcipotriene enhances the
response of psoriasis when used in conjunction with ultraviolet light therapy
(UVB), a treatment involving exposing the skin to ultraviolet-B light.
Calcipotriene also increases the effectiveness of PUVA, a treatment involving
the use of a prescription medication called psoralen and exposure to
ultraviolet-A light. These enhanced responses can lead to faster remission.
While calcipotriene is not compatible with topical therapies such as
salicylic acid, ammonium lactate and some corticosteroids, it can be used with
halobetasol propionate, a topical steroid. Studies have shown that when
calcipotriene and halobetasol are applied one on top of another, twice daily,
their combined effect is superior to either treatment alone.
Even more promising is this combination for long-term treatment. "A
regiment of halobetasol ointment applied on the weekends and calcipotriene
ointment applied on the weekdays is capable of maintaining remission in
76 percent of treated patients," said Dr. Lebwohl. "That's compared to the
40 percent of patients who used only corticosteroid on the weekends and were
able to maintain remission."
Tazarotene, a retinoid made from Vitamin A, also has positive interactions
with other psoriasis therapies. It is compatible when mixed with most topical
corticosteroids, resulting in less irritation and greater efficacy.
Short-contact tazarotene therapy, applying tazarotene for one to five minutes,
results in the effective clearing of psoriasis with reduced irritation.
However, tazarotene does increase the risk for redness and sunburn during UVB
and PUVA treatments; consequently, ultraviolet doses should be lowered by
approximately one-third when this treatment is added to a phototherapy
New Therapies Show Promise
Clinical trials are just beginning in the United States on topical
calcitriol, a vitamin D synthetic. It has proven safe and effective for the
treatment of psoriasis, but is being tested for its efficacy before and after
phototherapy, since it blocks transmission of UVB, narrow-band UVB, and PUVA.
"New treatments for psoriasis are making the management of the disease
easier for patients," said Dr. Lebwohl. "And the possibility of combined
treatments offers even greater hope for those who struggle to find therapies
to assist them with this chronic condition."