Topicals 'extremely' effective - if used properly

Some dermatologists believe the topical treatment regimens already in place for psoriasis - such as corticosteroids, anthralin and salicylic acid - are extremely effective and even more than sufficient in battling mild to moderate psoriasis - if only patients would comply with prescribed treatment plans.

"The key to success in topical psoriasis treatment is good compliance. For the longest time, it seemed that dermatologists didn't fully appreciate the impact patients' compliance had on outcomes of topical treatments. Now, it is clear that our topicals work fantastically well - if patients use them and apply them as prescribed. Also, new vehicles as well as new combinations promote better use and efficacy," Dr. Feldman tells Dermatology Times.

Dr. Feldman cites research studies that found that 40 percent of patients with psoriasis are noncompliant, and he suspects the other 60 percent may not be fully truthful.

He says to encourage patients to be compliant, it is helpful to establish a strong physician–patient relationship and involve the patient in the planning of treatment.

Involving patients in the choice of treatment can relate to asking them which vehicle they believe would be most appropriate and acceptable for their skin and their lifestyle, and one they would responsibly use. Dr. Feldman believes that the drop in compliance may explain most, if not all, of the "tachyphylaxis" phenomenon observed with the chronic use of topical steroids in psoriasis patients.

Stepping up return visits within one or two weeks after the initiation of treatment may also coax patients into a more steady compliance and adherence to the treatment.

Dr. Feldman says when patients see that the medication works, they will be more likely to use it long-term.

As for the vehicles used, Dr. Feldman stresses that ointments are not necessarily stronger than other, less messy vehicles.

"Look at the topical corticosteroid clobetasol propionate," he says. "It can be applied to the skin in an ointment, cream, gel, solution, foam, shampoo, lotion and spray, with each vehicle being capable of delivering the active molecule through the skin."

COMBINATIONS BENEFICIAL

Dr. Feldman says combining treatments like topical calcipotriol and topical corticosteroids proves to be very beneficial in the treatment of psoriasis.

He says the combination provides much faster relief in patients, and that the corticosteroids prevent the irritation that is sometimes seen with the topical calcipotriene, particularly when it is applied as a monotherapy.

According to Dr. Feldman, the first step in successfully managing patients with psoriasis is to address their psychosocial needs. He says the best way to achieve this is to touch them, ask them a few questions and let them know that you are understanding, compassionate and knowledgeable. Setting up a relationship in which the patient trusts the physician's advice is a solid beginning to good compliance and to successful therapy.

"Doctors should not overly scare patients with the side effects of medications, especially not at the first visit," he says. "This will increase adherence to treatment. Long-term side effects of treatment can be discussed in more detail after one or two weeks into therapy at the return visits. Physicians will find that topical therapies will be more effective when patients actually apply them."