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Intertriginous and scalp psoriasis has always been difficult to treat, mostly due to a lack of patient adherence. Using novel preparations as well as appropriate vehicles can significantly increase patient compliance and lead to improved treatment outcomes, according to one expert.
Detroit - Intertriginous and scalp psoriasis has always been difficult to treat, mostly due to a lack of patient adherence. Using novel preparations as well as appropriate vehicles can significantly increase patient compliance and lead to improved treatment outcomes, according to one expert.
"The main issue with the treatment of scalp psoriasis is compliance," says Linda F. Stein Gold, M.D., director of clinical research, division head, department of dermatology at Henry Ford Hospital, Detroit. "It can be very difficult to have patients adhere to their prescribed therapeutic regimens, and despite their best intentions, patients will not want to use anything that they perceive as making their hair greasy or dirty."
Foam products can contain mid- to high-potency corticosteroids such as betamethasone valerate or clobetasol propionate, respectively. According to Dr. Stein Gold, these products can encourage patients to comply with their treatment protocol, because they leave minimal residue on the scalp.
"Foam-based products work really well in scalp psoriasis and can significantly help increase compliance. While being cosmetically acceptable and well tolerated by patients, foam is an excellent vehicle for this indication and gets great penetration," Dr. Stein Gold says.
Additionally, clobetasol propionate spray is equipped with a novel applicator, which can be very effective in better targeting scalp psoriasis lesions.
New preparations that can be used in scalp psoriasis include a novel suspension vehicle containing calcipotriene 0.005 percent and betamethasone dipropionate 0.064 percent (Taclonex, Leo Pharma). Used once a day, this vitamin D analogue and class 2 corticosteroid proves to be more cosmetically elegant for the scalp because it is a lighter vehicle.
A recent eight-week study with the preparation showed that 71 percent of patients were clear or almost clear of scalp psoriasis symptoms, which was statistically better than either of the individual ingredients or the vehicle (Jemec G, Ganslandt C, Ortonne JP, et al. J Am Acad Dermatol. 2008;59(3):455-463).
Other novel treatment approaches for scalp psoriasis include a broadband UVB light fiber-optic comb. This light-therapy comb can be applied directly to the scalp to target scalp lesions and further help improve outcomes. In a pilot study, the comb was applied three times a week for 12 weeks and helped to achieve significant improvements in scalp psoriasis symptoms (Taneja A, Racette A, Gourgouliatos Z, et al. Int J Dermatol. 2004;43(6):462–467).
According to Dr. Stein Gold, potent topical corticosteroids are effective in intertriginous psoriasis. Because of the increased risk of atrophy, however, alternative treatment modalities should be explored. Here, topical immunomodulators such as pimecrolimus (Elidel, Novartis) and tacrolimus (Protopic, Astellas Pharma) can often be the treatment of choice.
"Commonly prescribed for the treatment of atopic dermatitis, these two preparations can also be very useful in the treatment of inverse psoriasis and can achieve a very good and quick clearance of symptoms," Dr. Stein Gold says.
Other novel preparations used for intertriginous psoriasis include vitamin D analogues such as calcitriol ointment and calcipotriene ointment. According to Dr. Stein Gold, these therapies can be very useful in sensitive areas such as the intertriginous zones, particularly where other modalities may be considered suboptimal or fall short of therapeutic goals.
"The treatment of the scalp and the intertriginous areas in psoriasis can be a challenge. However, I believe we have some good treatment options which can help control and manage symptoms. Physicians should consider these novel approaches when addressing these notoriously difficult-to-treat areas of psoriasis," Dr. Stein Gold says.
Disclosures: Dr. Stein Gold is a principal investigator and consultant for Galderma, Stiefel and Leo Pharma.