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Dermbits

Should we really care about systemic safety when treating Plaque Psoriasis with topical therapies? 

Psoriasis

You, I think we should always be aware of ways to enhance patient safety. In particular, I think we might consider being even more vigilant in psoriasis patients who are already immune suppressed with a systemic biologic. In these patients, if they need adjunctive therapy with a topical, it might make sense to reach for a topical that demonstrates less systemic steroid absorption and therefore less risk for HPA axis suppression. That might be a nonsteroidal like topinoroff or reflumalast. Or it could be a topical corticosteroid that's formulated for less systemic absorption. Interestingly, a phase two study for empoise, for example, showed significantly less systemic concentration of clobatazol propionate when compared to clavatazol zero 5% cream.