Psoriasis is a lifelong condition that is currently not curable and needs long-term treatment. Since the identification of psoriasis as a specific skin condition and the use of coal tar for psoriasis treatment many centuries ago, psoriasis medications have come a long way. Over the past decades, as the result of better understanding of the underlying pathology of psoriasis, clinical research efforts aimed at examining the efficacy and safety of drugs and identifying new treatments, as well as increased interest in individualized treatment, have led to the development of new therapies. Although many of these therapies are effective, symptom reduction, cosmetic clearing of the skin, and better quality of life remain a challenging goal for patients and clinicians.
Topical corticosteroids and nonsteroid agents such as vitamin D either as monotherapy or combination therapy are the mainstay of psoriasis treatment and often serve as first-line therapy for most patients. Patients who are receiving systemic therapy may also need additional topical therapy to achieve skin clearing. Choice of treatment for each patient depends primarily on severity of disease, treatment efficacy, side effect profiles, including drug allergy, and patient preferences.
This educational supplement features highlights of a CME/CE independent satellite symposium, which was held on November 5, 2015, at Skin Disease Education Foundation’s 16th Las Vegas Dermatology Seminar. It provides an overview of topical therapy for mild to moderate psoriasis, with a focus on the efficacy and safety data and mechanisms of action of new and emerging treatment modalities. Practical approaches for difficult-to-treat areas are presented to help clinicians tailor therapy according to individual patient profiles. The role of the vehicle and its effect on drug efficacy and patient acceptance are discussed. Strategies that influence drug efficacy and care of patients, and approaches to improving patient adherence to medication are also discussed.
The goal of this educational activity is to provide clinicians with up-to-date information on topical therapy for mild to moderate psoriasis that will help them to optimally manage their patients’ psoriasis and achieve improved outcomes.
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The University of Louisville and Global Academy for Medical Education LLC. The University of Louisville is accredited by the ACCME to provide continuing medical education for physicians. The University of Louisville Office of Continuing Medical Education & Professional Development designates this enduring material for a maximum of 2.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This program has been approved by the Kentucky Board of Nursing for 3.0 contact hours through the University of Louisville Hospital, provider number 4-0068-7-16-820. The Kentucky Board of Nursing approval of an individual nursing education provider does not constitute endorsement of program content. Participants must complete the entire session, provide license, and complete the evaluation to receive contact hours
Method of Participation
Participants should read the activity information, review the activity in its entirety, and complete the online post-test and evaluation. Upon completing this activity as designed and achieving a passing score on the post-test, you will be directed to a Web page that will allow you to receive your certificate of credit via email or may print it out at that time. The online post-test and evaluation can be accessed at http://tinyurl.com/TBD2015.
Inquiries may be directed to Global Academy for Medical Education [email protected] or (973) 290-8225.
Psoriasis is a distressing, chronic inflammatory disease characterized by thickened, scaly, erythematous, plaques on the body and scalp.1,2 It is estimated that 7 million Americans—about 2% of the population is affected with psoriasis.3 The majority of patients with psoriasis have localized disease that is manageable by topical therapy alone. Despite a range of effective therapies being available, patients are not receiving appropriate treatments. A National Psoriasis Foundation survey4 showed that, a large proportion of patients with mild to moderate psoriasis were dissatisfied with the treatments they had received, and one third of patients did not use psoriasis medications as directed.
Currently approved topical treatments for psoriasis include prescription medications such as corticosteroids (most commonly used), vitamin D derivatives, vitamin A derivatives (tazarotene), anthralin, tacrolimus and pimecrolimus, and over the counter (OTC) topicals such as salicylic and tar.5 To be effective, topical treatments must be prescribed in sufficient quantities calculated according to the BSA and used consistently, and consideration must be given to the choice of vehicle (ointment, cream, lotion, gel, or foam). All of these are important factors in patient adherence and, therefore, drug efficacy.
The availability of new topical drugs for mild to moderate psoriasis and newer vehicles has broadened the landscape of psoriasis management, offering additional treatment options for patients. These advances however complicate treatment decision-making and present a variety of challenges for healthcare professionals. Clinicians must be able to effectively and safely use topical therapies. They must be able to evaluate and analyze recent clinical data on new and emerging molecules, and new formulations and vehicles that may improve patient adherence. In addition, they must be knowledgeable about how best to integrate these therapies into their practice to optimize clinical outcomes while improving patient adherence.
This supplement focuses on current and emerging topical treatment options for mild to moderate psoriasis with discussions on efficacy, safety, and strategies to minimize side effects. An overview of impact of drug vehicles on treatment efficacy, medication safety, and patient preferences is presented, and practical approaches for optimizing patient outcomes are offered. In particular, strategies for improving patient adherence to medications are addressed.
At the conclusion of this activity, participants should be better able to:
- Interpret and evaluate emerging clinical trial data related to the use of new molecules and new formulations of topical treatments used in mild to moderate psoriasis.
- Discuss topical treatments including corticosteroids and nonsteroidal topical agents (such as those containing vitamin D, topical immunomodulators, and tar) in the treatment of psoriasis.
- Explain the role of vehicle in topical drug delivery and patient adherence.
- Discuss four key issues—quantity of medication prescribed, vehicle type, adverse events, and allergic reactions—that can affect patients’ acceptance and use of topical therapies
As a provider accredited by the ACCME, the Office of CME & PD, School of Medicine, University of Louisville must ensure balance, independence, objectivity, and scientific rigor in all its sponsored educational activities. All planners, faculty, reviewers, and other persons that affected the content of this CME activity were required to submit a financial disclosure form from which relevant conflicts of interest were determined. The persons below disclosed the following:
Linda F. Stein Gold, MD, Consultant: Anacor Pharmaceuticals, Eli Lilly and Company, Galderma Laboratories, L.P., LEO Pharma Inc., Novartis Pharmaceutical Company, Pfizer Inc., Sandoz, Taro Pharmaceutical Industries Ltd., and Valeant Pharmaceuticals North America LLC. Speaker: Galderma, LEO, Novartis, and Valeant. Grant Research/Support: Anacor, Galderma, GlaxoSmithKline, LEO, Novartis, Pfizer Inc., Sandoz, Taro, and Valeant.
CME Content Peer Reviewer: Timothy S. Brown, MD, University of Louisville, has no relevant financial relationships to disclose.
The CME & PD Staff and Advisory Board have nothing to disclose with the exception of Douglas Coldwell, MD, Speaker: Sirtex, Inc. ; Consultant: DFine, Inc.
Global Academy for Medical Education Staff: Sylvia H. Reitman, MBA, DipEd; Jenny Campano, Shirley V. Jones, MBA; and Jayasree Gokhale, PhD have no relevant financial relationships to disclose.
Off Label/Investigational-Use Disclosure
This activity discusses the off-label use of immunomodulators tacrolimus and pimecrolimus for psoriasis, which are US Food and Drug Administration (FDA) approved for atopic dermatitis. In 2005, FDA issued an alert about a possible link between these agents and lymphoma and skin cancer in children, and placed a "black box" in the prescribing information in 2006.
Copyright © 2016 by Frontline Medical Communications Inc. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission from the Publisher. Printed in the United States of America.
Publication of this CME/CE article was jointly provided by The University of Louisville, and Global Academy for Medical Education, LLC, with Skin Disease Education Foundation (SDEF) and is supported by an educational grant from LEO Pharma Inc.
Dr Stein Gold has received an honorarium for her participation in this activity. She acknowledges the editorial assistance of Jayashree Gokhale, PhD, medical writer, and Global Academy for Medical Education in the development of this continuing medical education journal supplement.
Linda F. Stein Gold, MD, Consultant: Anacor Pharmaceuticals, Eli Lilly and Company, Galderma Laboratories, L.P., LEO Pharma Inc., Novartis Pharmaceuticals Corporation, Pfizer Inc., Sandoz, Taro Pharmaceutical Industries Ltd., and Valeant Pharmaceuticals North America LLC. Speaker: Galderma, LEO, Novartis, and Valeant. Grant Research/Support: Anacor, Galderma, GlaxoSmithKline, LEO, Novartis, Pfizer, Sandoz, Taro, and Valeant.
Address reprint requests to: Linda F. Stein Gold, MD, 2360 Heronwood Drive, Bloomfield Hills, MI 48302; [email protected].
1085-5629/13/$-see front matter © 2016 Frontline Medical Communications doi:10.12788/j.sder.2016.005