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Current topical treatments are described in monotherapy and combination schedules.
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Evidence is available that the combination of calcipotriol and potent corticosteroids is more effective and has less side effects compared with monotherapies.
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Adherence is relevant for the success of a topical treatment.
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New small molecules provide opportunities for advances in new topical treatments of psoriasis.
An Update on Topical Therapies for Mild-Moderate Psoriasis
Section snippets
Key points
General introduction
Topical therapies are the first-line treatment in most patients with psoriasis.1 In general treatments are given for short episodes. In patients who use systemic treatments or biologics, a topical treatment may be indicated for residual recalcitrant lesions. Combinations of several topicals or a topical and a systemic treatment is common practice.
Adherence to treatment may be a limitation of topicals. In particular if a treatment has a slow onset of efficacy or the treatment offers a practical
The current position of classical topical agents
The three classical topical therapies dithranol, tar, and salicylic acids have been used in the treatment of psoriasis for 50 to 100 years. Efficacy and safety studies at the highest level of evidence are sparse. Methods of classical treatments are not standardized and different protocols in different treatment settings are used. Therefore, the interpretation of studies comparing classical and more innovative topical results cannot be generalized.7 When first-line topical treatments and
The current position of first-line topical agents
The evidence-based approach to estimate efficacy and safety of topical treatments is hampered because few randomly controlled trials are available for the classical topical treatments. Evidence-based data for corticosteroids are less than for vitamin D–based treatments and tazarotene.12 Strategies containing potent corticosteroids (alone or in combination with a vitamin D analogue) or very potent corticosteroids have dominated the treatment progress for psoriasis on the trunk, limbs, and scalp.
Beneficial combinations
Combination of potent corticosteroids with calcipotriol has been studied most extensively and should be regarded as an efficacious and safe treatment option, with the two-compound single combination product shown to be a practical remedy.30, 31
Other advantageous combinations, with limited evidence, are the combination of tazarotene gel with corticosteroid creams and the combination of dithranol and corticosteroids.
Future perspectives of small molecules
In normal skin, molecules with a molecular weight higher than 500 Da are not capable of crossing the stratum corneum (the 500-Da rule) (Table 1).30 The 500-Da rule is an important estimation as to whether a small molecule is small enough to be successful as a topical treatment.
WBI-1001 (2-isopropyl-5-[(E)-2-phenylethenyl]benzene-1,3-diol) is a nonsteroidal, anti-inflammatory, new chemical entity that was originally derived from the metabolites of a group of bacterial symbionts of
Summary
Topical treatment of psoriasis remains the mainstay for most patients. Vitamin D preparations in combination with corticosteroids of various potencies remain the most important active ingredients for maintenance of clinical response. New molecules have not been introduced for nearly two decades. Fortunately, there are several small molecules in various stages of clinical development that show promise as innovative new agents for the topical treatment of psoriasis.
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