Experts discuss the landscape of topical drugs for plaque psoriasis (PP) and key factors in treatment options.
Lauren Miller, MPAS, PA-C: Let’s talk about topical therapy. Evidence shows that over 90% of patients who have plaque psoriasis are on topical therapy. Sadly, a large majority of patients who have moderate to severe psoriasis are only on topical therapy, which is a disservice. But for topical therapy, there are shortcomings. We sometimes have to sacrifice efficacy for safety or tolerability. Let’s talk specifically about some of those shortcomings. What are your thoughts when it comes to choosing a specific topical therapy?
TJ Chao, MPAS, PA-C: The easy target is the adverse effects of topical steroids and their limitations of use.
Lauren Miller, MPAS, PA-C: Because those have been the gold standard forever.
TJ Chao, MPAS, PA-C: It’s all we’ve had for a long time that was actually effective. You have to worry about skin atrophy, striae, and causing damage to the skin. If they use the wrong topical in the wrong location, that can cause big problems. I’ll tell you it’s an issue if you’ve got medical assistants entering in the prescriptions into the EMR [electronic medical record] and they don’t list where that clobetasol should go or put the clobetasol to the groin by accident. If you don’t catch it, that could be a big problem. That’s a huge limitation. Also, 1 problem we’re having is that the cost of some of the topical steroids have become inaccessible.
Lauren Miller, MPAS, PA-C: Even the generic options.
TJ Chao, MPAS, PA-C: We almost wish we had coupons for all the other branded products because we could have access to those medications more easily. Things like halobetasol and clobetasol have become difficult to access.
Lauren Miller, MPAS, PA-C: Let’s also think about the systemic effects of topical steroids. Sometimes we forget that patients are getting the systemic absorption and what those systemic sequelae are going to be from using them long term. If we had to pick a perfect topical steroid for a patient, talk to me about what yours would look like or what that would be.
TJ Chao, MPAS, PA-C: Everyone wants the unicorn. They want the highly effective product that doesn’t have safety concerns associated, or the safety concerns are minimal.
Lauren Miller, MPAS, PA-C: So you don’t have to sacrifice efficacy for safety or vice versa?
TJ Chao, MPAS, PA-C: Right. And it’s easy to apply. It’s not thick and gooey, and it absorbs quickly into the skin. That’s the unicorn we’re looking for.
Lauren Miller, MPAS, PA-C: I’d want something—you could call it the unicorn because there aren’t many options—that you could apply to all areas of the body. That’s where [drug] vehicle comes in. For patients, especially where I am, cost is a limiting factor. So if you have to prescribe multiple products for the different body areas, that could be problematic too. I’m looking for something that can be put on all body areas because it’s safe. I want something that I can use from nose to toes. But I also want something you can put on all those areas that’s going to feel good to the patient and they’re not going to mind using. Because if they don’t want to use it and they’re not going to apply it, then they’re not going to get better. Right?
TJ Chao, MPAS, PA-C: Exactly.
Transcript edited for clarity.