Current Effective Topical Therapies in the Management of Psoriasis

Anil Kurian, MN; Benjamin Barankin, MD, FRCPC

Disclosures

Skin Therapy Letter. 2011;16(1):4-7. 

In This Article

Abstract and Introduction

Abstract

Topical therapy forms the cornerstone of treatment in the management of psoriasis. It plays a significant role as monotherapy in mild to moderate psoriasis, and it is used predominantly as adjunctive therapy in moderate to severe forms of the disease. Over the past decade, the topical treatment of psoriasis has evolved from the age-old applications, such as coal tar, to the more cosmetically acceptable and efficacious options containing topical corticosteroids, vitamin D analogues, and combined agents. With the advent of topical therapies in tailored vehicles and sophisticated delivery modes, the outlook for effectively managing psoriasis with topical approaches appears promising. To ensure therapeutic success, patient education about the disease, treatment options, proper administration, and adverse effects is essential, which will alleviate the common problem of poor patient adherence and promote more optimal clinical outcomes.

Introduction

Psoriasis is a chronic, recurring inflammatory disease that affects the skin, scalp, and joints.[1] The typical lesions are pruritic, erythematous, and exhibit well-demarcated papules and plaques with silvery-white scales.[2] Psoriasis affects 2% of the population and ranges in severity from mild to severe; patients with moderate to severe disease experience significant deterioration in quality of life. It affects men and women equally. The age of onset of psoriasis follows a bimodal distribution (peaks between ages 20 to 30 years and again between the ages of 50 to 60).[3] Both genetic and environmental factors have been implicated in the pathophysiology of psoriasis. About 35% of patients with psoriasis have a family history of the disease. Several environmental factors can trigger psoriasis in susceptible individuals: infection (most commonly streptococcal infection); trauma to the skin (Koebner phenomenon); drug reaction (e.g., lithium, beta blockers, anti-malarial drugs, non-steroidal anti- inflammatory drugs, and glucocorticoids); and stress.[2]

The clinical presentation of psoriasis varies depending on the morphologic subclass. Plaque psoriasis is the most common subtype and is usually concentrated on the extensor surfaces (i.e., elbows, knees, and lumbar back), scalp, genital areas, palms, soles, joints, and nails.[3] Removal of scale causes sites of punctate bleeding (Auspitz' sign), a sign of historic note. Therapy varies depending on disease severity and the degree of body surface area involvement. However, the vast majority of patients (approximately 80–90%) present with relatively mild disease and have only limited involvement of the skin, which can be well- controlled with topical therapy.[4]

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