Critical Considerations on Optimizing Topical Corticosteroid Therapy

Topical corticosteroids are mainstays of dermatologic therapy used to treat psoriasis and atopic dermatitis, among other conditions. They therapeutic class, typically described on a rating scale based on their potency as defined on the vasoconstrictor assay (blanching of skin upon application to a healthy subject). There can be important clinical considerations that influence the prescriber’s selection of a particular topical corticosteroid product for an individual patient. Both innovator (branded) and generic topical corticosteroids are available. Psoriasis is a common, chronic, immune-mediated inflammatory skin condition associated with disability (arthralgia, pruritus) and psychosocial distress leading to decreased quality of life.1 In a study of 32 patients with moderate-to-severe plaque psoriasis treated with a 24-week course of adalimumab, the Psychological Well-Being Index found that untreated psoriasis was associated with as much psychological impairment to the patient’s well-being as major medical diseases, such as congestive heart failure, diabetes, breast cancer, and coronary artery disease.2 Global prevalence of psoriasis is 0 to 11.8 percent.3 Psoriasis has recently been associated with numerous serious comorbidities, including cardiovascular disease, diabetes mellitus, depression,4 and cancer.6 Genetic and environmental factors likely influence psoriasis,3 with prevalence greater among Caucasians (2.5%) than African-Americans (1.3%).6 First-line treatment of psoriasis involves topical corticosteroids and/or vitamin D analogs, which are similarly effective.7 Atopic dermatitis is a chronic, recurrent, often treatment-resistant, inflammatory skin condition that occurs in children and adults.8 Atopic dermatitis is surprisingly common: About 17 percent of United States children have atopic dermatitis, of whom about 40 percent will continue to suffer from the condition into adulthood.9 Guidelines advocate the use of topical corticosteroids as first-line therapy for atopic dermatitis.10,11 The purpose of this roundtable discussion was to share general prescribing considerations, pearls and pitfalls, and observations of the use of topical corticosteroids in dermatology. In February of 2015, four dermatology thought leaders convened for a roundtable meeting to discuss optimizing topical corticosteroid therapy. The primary objective of this meeting was to bring together a panel of experts to discuss general prescribing considerations, treatment success, clinical studies, patient preferences and empowerment, adherence, product selection, brand (innovator) products versus generics, prescribing pathways, the role of systematic patient education, and potential pearls and pitfalls. The roundtable discussion and this supplement were supported by Taro Pharmaceutical Industries Ltd.