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American Academy of Dermatology Issues New Guidelines For The Management of Psoriasis With Topical Therapies
Date:3/2/2009

pectations with practical considerations. For example, patients who want continual clearance of psoriasis with no visible lesions inevitably will be disappointed with topical therapy because of the need for a continuous intense topical regimen that can be very difficult to achieve and maintain. Others may prefer only intermittent treatment with little interest in spending considerable time managing their condition.

"It is important to determine each patient's goals and then develop a strategy to help fulfill his or her expectations, while also being practical and realistic," said Dr. Hanke.

Method of Application

The choice of the therapy's vehicle (the form in which the medicine is delivered) can significantly alter the use and penetration of the medication and, as a result, alter its effectiveness. Several vehicle types for topical medications are available: ointments, creams, solutions, gels, foams, tape, sprays, shampoos, oils and lotions. The guidelines advise that while different vehicles are indicated for different body sites, the optimal choice should be based on what vehicle the individual patient is most likely to use on a regular basis.

"Areas with hair such as the scalp can be treated with solutions, foams, shampoos, sprays, oils, gels or other vehicles, with individual patients having different preferences among these options," said Dr. Hanke. "Some patients may prefer a less greasy preparation, perhaps a cream for daytime use, and may be willing to use an ointment, which is more effective but less cosmetically appealing, at night."

Use of Concurrent Therapies

In some cases, topical medications can be used concurrently to take advantage of varied mechanisms of action. When this is the case, patients may be instructed to apply the various medications at separate times throughout the day, and physicians also need to be aware of compatibility issues among the
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SOURCE American Academy of Dermatology
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