Linda Stein Gold, MD, and Jennifer Soung, MD, discuss real world experience of using roflumilast for plaque psoriasis therapy.
LindaStein Gold, MD: We’ve talked in depth about these 2 options. Jennifer, you’ve had experience with both. Can you tell me a little about some of your patients for whom you’ve used roflumilast? What was interesting about them?
Jennifer Soung, MD: One patient comes to mind because he was a patient who’s borderline 10%. Should I do a topical, or should I do a systemic? In general, systemics are much more effective than our topicals. I was debating on top of the fact that he has plaques in areas where there’s keratinization. There are super micaceous plaques on the knees, and I’m not sure if that topical is going to penetrate at all, but this patient was very concerned about systemic adverse effects. I said, “Fine, we’re going to give a topical a try.” I was so surprised when he came back. He was like, “Dr Soung, what company makes this? I want to buy its stock.”
LindaStein Gold, MD: That’s how you know that they like it.
Jennifer Soung, MD: I’m quite impressed with it. It’s made me rethink our topical approach. In the past, with topical steroids, we knew the duration of use was going to be limited. Now it simplifies our treatment approach because we can use roflumilast in any body area, and there’s no limit on the duration.
LindaStein Gold, MD: When I had a patient walk in with a bag, this was 1 of the heaviest bags I’d ever seen. All I thought was that you need to simplify your regimen. That was when I could say, “You know what? Put the bag away. I’m going to give you 1 tube.” The patient did, and the reason they had a bag was because they had facial involvement, groin involvement, and thick areas on the elbows and knees. To simplify this regimen, here’s 1 tube. Wherever you use it, it’s once a day.
I have another patient for whom I could have used either of these 2 drugs; both would have been outstanding choices. He’d had intergluteal disease for years. Besides the fact that it was in an uncomfortable place, it was exceptionally itchy. You can imagine this poor gentleman trying to go through life sitting in business meetings. When you sweat, it gets a little more itchy. It gets worse. He used steroids. But this is an area where you can’t use a potent steroid for long periods of time. He had rubbed so much that it was lichenified: thick, scaly, and awful. In this case, I could have given him either 1, but it just so happens that tapinarof was out because it became FDA approved before roflumilast did. I gave him tapinarof. He came back, and for the first time, there was still some residual erythema. We were at week 6 when I saw him back, but he had pretty much cleared.
Transcript edited for clarity