Novel Topical PDE-4 Inhibitors: Challenges in Treating Immune-Mediated Inflammatory Skin Conditions

On the first day of Fall Dermatology Week 2022, April Armstrong, MD, MPH, addressed challenges in treating psoriasis, atopic dermatitis (AD), and seborrheic dermatitis (SD) during her session, “The Role and Utility of Novel Topical PDE-4 Inhibitors in the Management of Plaque Psoriasis, Atopic Dermatitis, and Seborrheic Dermatitis.”

First, Dr Armstrong described the challenges in treating immune-mediated inflammatory skin conditions (IMISCs) by noting that these dermatologic diseases severely impact patient quality of life and, although topical therapies are a go-to treatment for these patients, many aren’t satisfied with current therapies. This dissatisfaction is due to negative side effect profiles, inconvenient treatment regimens, modest efficacies, and patient preference to avoid topical steroids.

Regarding psoriasis, Dr Armstrong stated that for more than 2 years there have been no nonsteroidal therapies for plaque psoriasis approved, and available treatments often lead to a trade-off between efficacy and tolerability, making them less than ideal. Additionally, about 40% of patients with psoriasis don’t use their medications as directed.

For SD, she noted that although topical treatments include antifungals, steroids, immunomodulators, and dandruff shampoos, there is still a pressing need for efficacious and safe options in the long term.

Dr Armstrong then emphasized that topical agents have poor patient adherence because they are often more difficult for patients than oral medications. There’s also a lack of efficacy due to nonadherence, making medication adherence worse for chronic dermatologic diseases when compared with acute diseases.

However, Dr Armstrong followed up on this stating, “With all this taken into account, I think that opportunities do exist for developing more well-tolerated, as well as effective, topical therapies for patients with these inflammatory diseases.”

Next, she focused on 3 major PDE-4 inhibitors, including:

• Roflumilast
• Apremilast
• Crisaborole

Of the 3, Dr Armstrong stressed that roflumilast is the most potent. For psoriasis, roflumilast has displayed strong efficacy by achieving widespread Investigator’s Global Assessment (IGA) success, making it popular among patients. As for AD, although crisaborole is the approved topical PDE-4 inhibitor, roflumilast cream has been shown to improve the severity of AD. Finally, for SD, Dr Armstrong presented a study that showed roflumilast foam 0.3% was connected to significant and rapid improvement in redness, scaling, and itch.

Finally, Dr Armstrong concluded her session by sharing how to incorporate topical PDE-4 inhibitors into clinical practice for the right patients by noting that adherence improvement to topical treatment relies on:

• • • Choosing the right vehicle
    • Patient education
    • Follow-up visits or calls
    • Patient participation in treatment decisions
    • Positive patient-physician relationships

Reference
Armstrong A. The role and utility of novel topical PDE-4 inhibitors in the management of plaque psoriasis, atopic dermatitis, and seborrheic dermatitis. Presented at: Dermatology Week 2022; September 14-17, 2022; Virtual.