Novel Topical PDE-4 Inhibitors For Plaque Psoriasis, Atopic Dermatitis, and Seborrheic Dermatitis

On the first day of Dermatology Week 2022, April Armstrong, MD, MPH, opened her session, “The Role and Utility of Novel Topical PDE-4 Inhibitors in the Management of Plaque Psoriasis, Atopic Dermatitis, and Seborrheic Dermatitis,” by noting, “There are common unmet needs in inflammatory skin diseases and that created opportunities for new, well tolerated, and effective topical therapies for these inflammatory skin diseases.”

Dr Armstrong explained that “topical treatments remain as the main part of treating patients with limited psoriasis.” She listed the current topical therapies for psoriasis:

• Topical corticosteriods
• Topical calcineurin inhibitors (tacrolimus, pimecrolimus)
• Vitamin D analogues (calcipotriene, calcitriol)
• Keratolytics (tazarotene, salicylic acid)
• Combination therapies
  • Corticosteroid + Vitamin D analogue
  • Corticosteroid + keratolytic

Dr Armstrong then went on to share other types of topical PDE-4 inhibitors and emphasized that “not all PDE-4 inhibitors are created equal.” As an example, she noted, “Roflumilast, compared to apremilast and crisaborole, is multiple-fold stronger in terms of its affinity for PDE-4 and, therefore, it is… stronger and more potent than apremilast and crisaborole.”

For psoriasis, Dr Armstrong discussed the specific sites that are considered overall difficult to treat like elbows and knees. Based on a study she conducted, she noted, “With roflumilast (0.3%), even for the difficult-to-treat areas, such as elbows and knees, that have thicker plaques, 41% of the patients achieved Investigator’s Global Assessment (IGA) [scale] success, ie, clear or almost-clear IGA status with at least 2 grade points reduction from the baseline, compared to 5% in the placebo group.”

Dr Armstrong continued by moving towards the opposite end of the spectrum and discussed intertriginous psoriasis that is in steroid sensitive areas. She mentioned, “Roflumilast-treated patients had significantly more Worst Itch-Numeric Rating Scale success, ie, 4 points or more improvements in patients from the baseline.”

Additionally, Dr Armstrong talked about the foam version of roflumilast, which was very popular among patients, “Significantly more patients treated with roflumilast foam had body-IGA (B-IGA) success as early as 2 weeks.” And for the scalp psoriasis, she noted, “More than 50% of the roflumilast-treated patients achieved a 75% reduction in the Psoriasis Scalp Severity Index (PSSI-75).”

After psoriasis, Dr Armstrong geared toward atopic dermatitis (AD), “Crisaborole is the topical PDE-4 inhibitor approved for AD.” According to the data she presented, “Crisaborole 2% ointment is approved in patients older than 3 months with mild to moderate AD.” Also, as for roflumilast PDE-4 inhibitor for AD, she noted, “Roflumilast (0.15%) cream improved severity of AD.”

Lastly, Dr Armstrong discussed topical PDE-4 inhibitors for seborrheic dermatitis (SD). Regarding roflumilast she noted, “Roflumilast foam 0.3% demonstrated significant and rapid improvement in SD, redness, scaling, and itch.

Dr Armstrong wrapped up the session by suggesting the following helpful tips and methods for improving adherence to topical treatments:

• Choose the right vehicle.
• Educate patients.
• Conduct follow-up visits or calls.
• Encourage patient participation in treatment decisions.
• maintain 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; May 11–14, 2022; Virtual.