“Enstilar is a very effective product. What’s novel is that the foam formulation super-saturates the active ingredients on the skin, so there is a higher concentration of drug delivered. We find that it works well in tough-to-treat places. It’s something I reach for when somebody who’s on a biologic has a couple of stubborn plaques.”
Patients also like the once-daily formulation, Dr. Han adds.
Halobetasol propionate-tazarotene lotion (Duobrii, Ortho Dermatologics) combines a potent steroid and a retinoid for synergistic effects. Halobetasol helps suppress tazarotene-induced irritation, Dr. Han explains, while tazarotene helps prevent steroid-induced skin atrophy. He likes that the product demonstrated safety when tested in near-continuous use for one year (with maximum continuous exposure to 24 weeks).7
“That provides some comfort regarding longterm treatment that we currently do not have with such a strong steroid,” Dr. Han says.
The product also may have off-label indications such as AA and vitiligo, he says, where previous combinations of retinoids and anti-inflammatories have shown some synergy. Halobetasol propionate 0.01% lotion (Bryhali, Ortho Dermatologics) has shown similar efficacy to halobetasol 0.05% cream.8
“And Bryhali is as efficacious in a oncedaily, rather than twice-daily, application,” Dr. Han says. He has been using a fair amount of halobetasol 0.01% in psoriasis and other topical steroid-responsive skin conditions.
“I take heart in the fact that it was tested and approved in a longer treatment course — eight weeks of continuous use. People sometimes forget that some of the early topical clobetasol and betamethasone diproprionate studies had hypothalamic-pituitary-adrenal axis suppression in around 50% of patients, and you’re not supposed to use those longer than two weeks at a time,” he says.
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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