Topical therapies remain ‘bread and butter’ of psoriasis treatment

MIAMI BEACH, Fla. — Despite the plethora of biologics for psoriasis, the vehicle of treatment matters and topical therapies are here to stay, according to a speaker at South Beach Symposium.

“We are very lucky in that we have a lot of choices in biologics; however, topical treatment remains our ‘bread and butter’ in dermatology,” Leon H. Kircik, MD, clinical associate professor of dermatology at Indiana University School of Medicine and a dermatologist at Physicians Skin Care in Louisville, Kentucky, said during a presentation. “When thinking about topicals, we always think about the vehicle of treatment, which has become the big story in dermatology. Vehicles do matter in dermatology.”

A “hot topic” topical, halobetasol propionate, is available in many different vehicle forms, Kircik said.

“We have access to the same molecule in various vehicle forms. However, halobetasol foam is a corticosteroid indicated for the topical treatment of plaque psoriasis in patients 18 years and older and is the only foam that we have at 0.05% concentration,” he said. “Data have shown that up to five times more patients achieved treatment success with the 0.05% halobetasol propionate foam compared with other vehicle forms of the same topical.”

Halobetasol propionate at 0.01% concentration is also available in lotion form.

“There is another new formulation of halobetasol that appears to have very similar results as the foam,” Kircik said. “What is unique here is that with the lotion, halobetasol propionate is dispensed via an oil droplet in combination with tazarotene.”

Both halobetasol propionate and tazarotene are solubilized and coexist within oil droplets, according to Kircik, and efficient epidermal delivery of a honeycomb-like structure from polymeric emulsion suspension enhances deposition of active ingredients on the skin surface.

“Integrated delivery oil droplets, which contain both active and hydrating ingredients, allow the agents to reach affected areas at the same time so that the agents have simultaneous contact with skin surface,” he said. “It is important for dermatologists to understand that the two treatments cannot be purchased separately as lotions and combined in that way. It will not be as effective in that form. It is simple high school chemistry — the chemistry is not the same. The vehicle of topical treatment matters, and we need this unique vehicle to combine the two and to keep their concentrations high.”

Another effective topical foam treatment is calcipotriene plus betamethasone dipropionate.

“Calcipotriene plus betamethasone dipropionate foam is consistently more effective than the combination in other vehicle forms,” Kircik said. “The foam allows for super-concentrated actives on the skin, which has been proven in various clinical studies.”

In addition to foams, Kircik discussed a new technology from Denmark, dubbed polyaphron dispersion (PAD) technology.

“This involves a special-made oil-in-water dispersion technology in which the internal oil phase is stabilized by encapsulation in a thin yet robust aqueous film of surfactants,” he said. “Each droplet maintains its own physical-chemical stability without the need of excessive presence of surfactants in the external phase. Consequently, the formulations are characterized by very low amounts of surfactants. The less surfactants, the better the product. This is a unique vehicle formulation that can be used for any other type of actives, which is something that the company will be testing in the future.”

Looking ahead, Kircik said even more novel molecules with great vehicles are on the horizon.

“This is exciting because the availability of new topical molecules does not happen that often in dermatology,” he said. “Topical tapinarof is one new molecule that is very interesting because it works for atopic dermatitis pathways, but it also works for pathways in psoriasis. Data have shown a 65% IGA response rate in patients with psoriasis. It is a unique active that is quite impressive and may be a game-changer for psoriasis.” – by Jennifer Southall

Reference:

Kircik L. Topical therapies for psoriasis. Presented at: South Beach Symposium; Feb. 6-9, 2020; Miami Beach, Florida

Disclosure: Kircik reports he has relationships with numerous companies, including Abbott, Acambis and Allergan.