Recent research has shown that calcineurin inhibitors (TCIs), such astacrolimus ointment and pimecrolimus cream, may be effective in treating psoriasis, although they are currently only approved by the U.S. Food and Drug Administration (FDA) for the treatment of atopic dermatitis, another chronic skin condition in which the skin becomes itchy, dry and inflamed. TCIs interfere with the activation of T-cells, a type of white blood cell responsible for triggering immune responses that contribute to the development of skin conditions such as atopic dermatitis and psoriasis.
"In clinical trials, pimecrolimus and tacrolimus showed promise in treating facial psoriasis and inverse psoriasis, which is characterized by smooth, red lesions in the skin folds," stated Dr. Stein Gold.
"Tacrolimus inthe gel form is currently in clinical trials for the treatment of body psoriasis. Side effects tend to be mild and include minor itching and a sensation of warmth after application." Another new topical medication that has been approved by the FDA to treat moderate to severe plaque psoriasis is clobetasol propionate spray. In spray form, clobetasol propionate penetrates the skin easily to diminish the psoriasis plaques and minimize inflammation. In a recent study, patients using the clobetasol propionate spray over a four-week period saw a marked decrease in their disease severity, with most patients considering their psoriasis clear or almost clear by week four. In follow-up interviews after the completion of the study, the greatest proportion of patients still considered their psoriasis to be clear or almost clear.
"Patients like the spray because it is easy to use and not as messy as other topical medications," explained Dr. Stein Gold. "That is important because patients who like using a product will be more inclined to consistently use the treatment as directed, which will lead to more rapid results."
Combinations with topical corticosteroids also are effective for the treatment of psoriasis. A combination of calcipotriene and betamethasone dipropionate, a vitamin D analogue and a potent corticosteroid, was recently approved by the FDA in an ointment form for the treatment of psoriasis.
In a recent study of patients using the combination once daily, more than80 percent of patients with mild to localized psoriasis reported reaching a Psoriasis Activity and Severity Index (PASI) score of 50 or better after fourweeks, which means that this measure of psoriasis severity improved by 50 percent from the start of the study. The PASI is the standard measurement tool to determine what percentage of the body is affected by psoriasis and how
severe a patient's psoriasis is at any given time. In addition, many patients with severe psoriasis who participated in the study reported a reduction in PASI score of more than 70 percent.
