“Once you calm down the initial severe flare, they’re more likely to be able to maintain on crisaborole, and you optimize the safety and maximize the efficacy of the product in this way,” he says.
Thin-skinned areas such as the periocular area also tend to experience burning and stinging, says Dr. Han. He therefore recommends avoiding crisaborole ointment in such areas during acute disease flares, or refrigerating it or mixing it with a
moisturizer to improve tolerability.
“It has good efficacy and is an important part of the long-term treatment arsenal. We need more nonsteroidal topical anti-inflammatory medications like crisaborole to come to market,” Dr. Han says.
Although Pfizer is no longer pursuing a psoriasis indication for crisaborole ointment, Dr. Han sometimes uses it for inverse psoriasis.
“We want to avoid a steroid in areas such as skin folds that are prone to striae or cutaneous atrophy,” he says. “The medication has some utility there.”
COMBINATIONS FOR PSORIASIS
In psoriasis, says Dr. Han, there is room for combinations of existing agents with innovative vehicles. With calcipotriol-betamethasone diproprionate foam (Enstilar, LEO Pharma), he says, a mean Psoriasis Area and Severity Index (PASI) reduction of 73% was reported in phase 3 trials, but this data must be interpreted carefully because mean baseline PASI scores were between six and 10, reflecting a more moderate patient than in most trials of biologics.5,6
Dr. Han has been an advisor for Intraderm, Janssen, UCB and Eli Lilly; an investigator for MC2 Therapeutics; a speaker for Sun Pharma; an investigator and speaker for Pfizer; and an advisor and speaker for Sanofi Regeneron.
George Han MD. “New and Upcoming Topicals in Psoriasis and Atopic Dermatitis,” Atlantic Dermatological Conference. May 5, 2019. New York.
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