Learn more about the in-depth topics covered in the November 2023 Frontline Forum corticosteroid-responsive dermatoses supplement of Dermatology Times.
The November Frontline Forum corticosteroid-responsive dermatoses supplement of Dermatology Times, "Enhancing Patient Outcomes: Topical Therapy for Corticosteroid-Responsive Dermatoses", includes a collection of thought-provoking discussions and topical therapy management strategies from James Del Rosso, DO; Linda Stein Gold, MD; Jayme Heim, MSN, FNP-BC; TJ Chao, MPAS, PA-C; and Darren West, MPAS, PA-C. Be sure to take a look at the highlights from the supplement below. Also, don’t miss a moment of Dermatology Times by signing up for our eNewsletters and subscribing to receive the free print issue and supplements each month.
Recent approvals of multiple new topical therapies for psoriasis and atopic dermatitis (AD) have greatly enhanced the therapeutic armamentarium, and treatment for these common inflammatory skin diseases has become both an art and a science. However, the downside of so many available options is potential confusion for clinicians, who must weigh the pros and cons of each to fit patient symptoms, lifestyles, and condition severity. Because each agent has its own unique merits, the idea that older topical therapies are obsolete may not be true. In practice, the variations in clinical challenges faced by the clinician are vast. Given this, a topical agent thought to be outdated or ineffective may turn out to be the best agent for a particular patient. Although psoriasis and AD are caused by dysregulation in different parts of the immune system (psoriasis affects the Th1 signaling cascade while AD affects the Th2 cascade), they are both very responsive to topical corticosteroid therapy. Both diseases have seen recent approval for new oral and systemic therapies, including JAK inhibitors and biologic therapies.
Turning to epidermal barrier dysfunction, Del Rosso pointed out that using betamethasone dipropionate spray, which he refers to as a “sprotion” because it is a lotion that is sprayed onto the skin, offers some interesting advantages. When looking at the vasoconstrictor assay for this formulation, for example, it turned out to be of medium potency, compared with betamethasone dipropionate augmented, which is super potent. However, Del Rosso presented efficacy data out to day 15 showing that these 2 agents do not differ in their efficacy despite one agent being graded as weaker based on the vasoconstrictor assay. That is why the vasoconstrictor assay is a somewhat outdated measure, Stein Gold added. She said that she worries an augmented medication can easily pass into the dermis and constrict the deep vessels, which may lead to potential systemic concerns.
How does clobetasol cream 0.05% compare with clobetasol cream 0.025%? Both formulations use cream as the vehicle, but the 0.025% concentration is half that of the 0.05% concentration. Efficacy was shown to be the same at day 15. However, the hypothalamic-pituitary-adrenal (HPA) axis suppression was significantly less with the 0.025% concentration. Therefore, using half the concentration of clobetasol leads to similar efficacy as the higher concentration with less concern for HPA axis suppression.
“I don’t lose sleep over my concern of HPA axis suppression. However, with this data, you kind of would put it in a package. I do lose sleep over potential atrophy or especially over striae. So now we have a drug that’s offering me half of the active ingredient, half of the exposure, which although we’re not seeing the studies here, we are seeing the systemic exposure study. We’re seeing that there’s half the amount of drug. So I would hope that that would potentially lead to a minimized potential for the cutaneous manifestations,” Linda Stein Gold, MD, said.
Click here to view the whole series online.