RIO GRANDE, P.R. – When it comes to treating psoriasis patients with topical products, the location of the psoriasis helps determine the best vehicle for delivery, according to Dr. Eric W. Baum.

Some topical therapies work well when used alone, while others are more effective in combination with other products, Dr. Baum said at the annual Caribbean Dermatology Symposium. But the success of any topical psoriasis therapy depends on the vehicle, and the right vehicle varies for each patient.

"The vehicle can greatly influence percutaneous absorption and therefore increase therapeutic efficacy," said Dr. Baum of the University of Alabama at Birmingham.

"Topical psoriasis treatment is quite interesting, because there are so many different choices," said Dr. Baum. "I might use a foam on the hands because it is less sticky; I’ll use sprays with different types of nozzles to penetrate areas that are hard to reach."

Vehicle options for topical psoriasis therapy include cream, ointment, tape, gel, lotion, aerosol spray, foam, solution, shampoo, powder, and oil.

There is no silver bullet when it comes to psoriasis, but topical therapy remains many dermatologists’ first choice for initial treatment, noted Dr. Baum, who shared recent data on three products.

Foam

In a phase III study, clobetasol propionate 0.05% foam (Olux-E, Stiefel) significantly improved erythema, scaling, and plaque thickness in patients with mild to moderate plaque psoriasis after 2 weeks of use, compared with control foam. Based on these findings, the foam is considered to be safe for use in mild to moderate psoriasis patients aged 12 years and older, said Dr. Baum.

In a previous unpublished, company-funded study of Olux-E for moderate to severe atopic dermatitis, patients rated several cosmetic qualities of the foam higher than for other vehicles, including the ability to be easily spread, ease of application, quick absorption, lack of fragrance, and lack of residue, he noted.

Spray

Sprays can be an excellent choice for the scalp or other hairy areas, said Dr. Baum.

In an open-label noncomparator study of triamcinolone acetonide 0.2% spray (Kenalog, Bristol-Myers Squibb) for steroid-responsive dermatoses, 85% of 39 patients reported improvement after 7 days of use. In addition, 95% of patients said they preferred the spray over creams and ointments, 92% said they would request the spray for future use, and more than half reported satisfaction with the cooling effects of the spray (J. Clin. Aesthet. Dermatol. 2010;3:27-31).

The study also found that patients who applied the spray twice daily for scalp or leg psoriasis showed visible improvements after 1 week, suggesting that the long nozzle associated with the spray vehicle allowed for better penetration, said Dr. Baum.

Cream

For large areas of dermatoses, a biphasic cream may be particularly effective, according to Dr. Baum. He and his colleagues studied the effectiveness and patient acceptance of halcinonide 0.1% (Halog, Ranbaxy) for treating large, steroid-responsive dermatoses (J. Clin. Aesthet. Dermatol. 2011;4:29-33).

At baseline, 40 patients aged 23-85 years were diagnosed with moderate to severe dermatoses, and 83% had psoriasis (2 patients were lost to follow-up). After 28 days of treatment with halcinonide cream, 47% of patients were clear or almost clear, said Dr. Baum. And of equal importance, the vehicle was popular with patients; 95% said they "liked the way the product spread on the skin," Dr. Baum said. In addition, 87% said they would ask for the same cream again for another skin problem.