During her session, “What's New and Hot in Topical Therapy,” presented at the 2022 Fall Clinical Dermatology Conference, Linda F. Stein Gold, MD, imparted some of the best practices physicians can implement when using topical therapy in their clinic.

First, she addressed the use of topical therapies in treating psoriasis by stressing that combination therapy is generally better. One of the most efficient combination therapies Dr Stein Gold mentioned was halobetasol propionate and tazarotene lotion. When used once a day, about 40% of patients will achieve clear or almost clear skin after 8 weeks.

“And the unique thing about this drug is, when you stop using it, some patients continue to improve,” she added.

In fact, she shared a study where, when treatment was stopped, 63% of patients maintained their efficacy a month later and 14% of patients continued to improve and reached efficacy better than when they started the medication.

Next, Dr Stein Gold introduced a recently developed technology called PAD technology utilized to assist in stabilizing cream vehicles because they are a mix of oil and water. Typically, it takes a lot of surfactants to stabilize this formulation, which can impede penetration and become irritating; however, PAD technology creates a robust oil droplet that brings the internal oil phase to stabilization through encapsulating in a robust aqueous film. This solubility can lead to enhanced skin penetration. When this technology was combined with another topical therapy, calcipotriene/betamethasone dipropionate, findings showed that there was better efficacy and itch decreased dramatically.

Dr Stein Gold then discussed proactive therapy, noting that remission is maintained much longer than nonproactive approaches. One example she used to highlight this was calcipotriene/betamethasone dipropionate, which was used in a long-term proactive management of psoriasis study. The study results showed that 43% of patients experiencing a first relapse faced a reduction in risk compared with a reactive group. Additionally, the proactive group had 41 extra days in remission compared with patients in the reactive group.

Finally, Dr Stein Gold summarized the new and exciting topical therapies that are on the horizon. One category is topical JAKs, particularly ruxolitinib, which is a JAK1/2 inhibitor typically used to treat atopic dermatitis (AD) in patients aged 12 years and older. A topical JAK such as this one is safe and effective for treating AD on the face, body, and sensitive areas. She argued that physicians should obey the body surface area limit of 20% and warned them not to continuously use topical JAKs for extended periods of time. After reviewing all the upcoming topical therapies physicians could look forward to, Dr Stein Gold concluded that topical therapy is still the cornerstone of therapy.

Reference
Stein Gold L. What's new and hot in topical therapy. Presented at: Fall Clinical Dermatology Conference 2022; October 20–23, 2022; Las Vegas, NV.