Application feel, non-staining quality top preferences in topical psoriasis treatment

Key takeaways:

• Patients reported the most important topical treatment factors as application feel, non-staining quality and quick absorption.
• If disliked, 74.7% of patients will use a medication 1 week before discontinuation.

While topical formulas continue to be a primary treatment option in psoriasis, patients have reported certain characteristics that impact their adherence and willingness to use these medications, according to a study.

“Despite numerous topical treatment options available, over 50% of patients are dissatisfied with their psoriasis treatment and many prescriptions are never filled,” Alyssa Curcio, BA, of the center for dermatology research in the department of dermatology at Wake Forest School of Medicine, and colleagues wrote. “Patients’ expectations of topical treatment are not well characterized, and there is little information on their preferences for new types of vehicles.”

In an effort to understand patient perspectives, researchers evaluated the results of the National Psoriasis Foundation’s 17-question survey conducted in March 2022, which assessed psoriasis severity, signs and symptoms considered bothersome, treatment modalities currently used, topical therapy use frequency and vehicle preferences.

The researchers used descriptive analysis and relative frequency calculations for their statistical analysis of the qualitative data, according to the study.

Signs and Symptoms

Results showed that of the 411 patients surveyed, 83.9% self-reported moderate psoriasis. This was followed by 10.2% reporting their psoriasis as severe, 5.4% reporting it as mild and 0.5% reporting it as very severe.

As far as the most bothersome signs and symptoms of psoriasis, 78.8% of patients reported scaly appearance, 60% reported bleeding/oozing, 55% reported itch and 37.4% reported flaking.

More than 90% of patients reported a constant presence of itch, and 86% rated their itch severity as moderate. The most affected areas included the scalp at 67.9%, arms/elbows at 62.8%, trunk at 61.6% and hands/feet at 40.6%.

Treatment Preferences

At 76%, most participants reported using a topical treatment at least once weekly; however, only 8% said they used topicals alone whereas 72.5% reported the additional use of oral medication. These included biologics, cyclosporine or methotrexate.

Water-based creams emerged as the preferred topical treatment type for psoriasis (75.7%) closely followed by oil-based foam (70.8%). A significant decline in preference was observed in the remaining topical options, including gels (48.7%), solution (42.8%), lotion (21.2%), non-oil-based foam (17.5%), ointment (16.5%) and spray (6.3%).

When asked what formulation attributes were most important in topical therapy, 55.2% of patients said application feel, 49.9% said non-staining quality and 46.7% said quick absorption.

Other important characteristics included non-sticky texture (39.7%), application ease (28.5%), absence of unpleasant smell (22.4%), non-greasy feel (16.8%), rapid efficacy (14.1%), no stinging or burning (10%), lack of adverse skin reactions (9.7%) and once-daily application (6.8%).

Adherence

The study found that if patients did not like a topical treatment’s formulation, 74.7% will only use the medication for 1 week before discontinuation. Furthermore, more than 40% of patients said that they would reach out to another dermatologist if their topical medication caused a reaction.

“Though many effective topical treatments exist, poor adherence to therapy frequently prevents positive clinical outcomes, and patients will discontinue treatment if they do not see rapid improvement,” the authors concluded.

Curcio and colleagues found that the characteristics of formulations contribute greatly to patients’ willingness to adhere to treatment.

“Considering patient preferences and acceptability is important in treatment planning and will likely improve adherence and outcomes,” they wrote.