Physicians create guidelines for utilizing topical medications in psoriasis treatment

Key takeaways:

• Topical medications are widely preferred by physicians and patients to treat psoriasis.
• Steroidal agents should be paired with nonsteroidal agents such as vitamin D or vitamin A.

Since topical steroids remain the cornerstone of psoriasis treatment, a group of dermatologists specializing in psoriasis gathered to discuss the most current management guidelines for topical psoriasis treatment.

“Topical corticosteroids continue to be a mainstay of primary and/or adjunctive therapy for all severities of psoriasis,” April W. Armstrong, MD, MPH, professor of dermatology and associate dean of clinical research at Keck School of Medicine of University of Southern California, and colleagues wrote. “A group of dermatologists with expertise in the treatment of psoriasis gathered to evaluate current evidence on corticosteroid-containing topical medications and participated in a Delphi consensus process to generate statements that reflect the current state of evidence and help guide clinician decision-making.”

The Psoriasis Expert Group (PEG) developed nine statements concerning topical medication efficacy, patient quality of life, application frequency, medication “feel” on the skin, safety and tolerability.

The PEG agreed that topical medications are preferable among physicians and patients. The group also determined that the most important characteristics of topical medications for both physicians and patients was high efficacy, long-lasting results, less frequent application, rapid onset of action, a “feel good on the skin” texture and few adverse events at the application site.

The PEG also agreed that the benefit-risk profiles support the consideration of combination topical therapies such as a topical corticosteroid with a nonsteroidal agent such as vitamin D or vitamin A. This can be done prior to starting topical steroid monotherapy.

Further, the PEG only moderately agreed that lower rates of long-term side effects, such as skin thinning, are preferred by patients, but highly agreed that physicians prefer these lower rates of long-term side effects.

The PEG also noted that topical therapies that improve a patient’s quality of life are widely preferred among patients. A clinician can know whether the topical therapy is meeting a patient’s quality of life needs if that patient is able to resume their normal day-to-day activities.

“Ultimately, physicians should employ shared decision-making by participating jointly in health decisions with patients, discussing the benefits and risks of various treatment options, and considering the patient’s preferences and circumstances to find the best individual treatment plan,” the authors concluded.