Frontline Forum Part 3: Topical Therapy for Corticosteroid-Responsive Dermatoses

Read part 1 here.

Read part 2 here.

Comparing Clobetasol Cream Concentrations

How does clobetasol cream 0.05% compare with clobetasol cream 0.025%? Both formulations use cream as the vehicle, but the 0.025% concentration is half that of the 0.05% concentration. Efficacy was shown to be the same at day 15. However, the hypothalamic-pituitary-adrenal (HPA) axis suppression was significantly less with the 0.025% concentration. Therefore, using half the concentration of clobetasol leads to similar efficacy as the higher concentration with less concern for HPA axis suppression.

“I don’t lose sleep over my concern of HPA axis suppression. However, with this data, you kind of would put it in a package. I do lose sleep over potential atrophy or especially over striae. So now we have a drug that’s offering me half of the active ingredient, half of the exposure, which although we’re not seeing the studies here, we are seeing the systemic exposure study. We’re seeing that there’s half the amount of drug. So I would hope that that would potentially lead to a minimized potential for the cutaneous manifestations,” Linda Stein Gold, MD, said. This example highlights the need for clinicians to be very familiar with efficacy data, even with medications that use the same vehicle but have different concentrations.

Conclusions

The panelists provided a comprehensive overview of topical therapy approaches for corticosteroid-responsive dermatoses, discussing the roles of corticosteroids and nonsteroidal options. They highlighted their concerns regarding the adverse effects and limited clinical use of topical corticosteroids, and they also provided their thoughts on how medications can be useful and effective in practice.

They also had an in-depth discussion regarding topical therapy vehicles, formulations, and the importance of barrier dysfunction. “There’s a lot behind formulation and vehicle, which is why you do want to get a certain product, so you know exactly what it’s doing. It’s that particular chemical that makes a big, big difference in these different formulations. So that’s the secret sauce there,” Del Rosso said.

Real world, challenging cases were reviewed and highlighted the importance of vehicle and thoughtful strategies in using topical corticosteroids when limited by the FDA package insert mandating up to 2 weeks of continuous use only.

Additionally, the panelists shared pearls for the busy, practicing dermatologist, including how to counsel patients on topical corticosteroid use. They also highlighted the importance of patient education to combat misinformation that is rampant on social media. Additionally, the panelists agreed on the importance of barrier dysfunction in AD, noting patients should moisturize their skin every day to help decrease flares, repair barrier dysfunction, and ultimately lead to the need for less medication.

In listening to the panel, it is evident that it is an exciting time in the treatment of AD and psoriasis because many new topical agents have been released, with even more agents in the pipeline. Discussions such as this will help provide better care to their patients with inflammatory skin disease and ultimately lead to improved patient satisfaction.