Recent Advances in Drug Therapy for Psoriasis

Abstract

Drug options available for the treatment of psoriasis continue to increase rapidly. This review summarizes current concepts and developments in the therapeutic armamentarium. Tazarotene (0.05% and 0.1% gel) is a topical retinoid that has recently been approved for the treatment of psoriasis. While its clinical utility is limited by the development of significant irritation, a regimen combining topical corticosteroids in the morning with tazarotene in the evening results in greater efficacy with fewer side effects.1 Tazarotene can also be combined with corticosteroids for once-a-day application. Most corticosteroids are compatible with tazarotene, and anecdotal reports suggest that they further reduce irritation without compromising efficacy. Tazarotene cream is currently under investigation. Calcipotriene or calcipotriol (ointment, cream, scalp lotion), a vitamin D3 analog, has been used for years for treating psoriasis. It is more effective when combined with topical corticosteroids, particularly superpotent corticosteroids.2 Use caution when combining calcipotriene with other medications because some drugs inactivate the molecule.3 Salicylic acid, for example, inactivates calcipotriene once the two products are compounded. Calcipotriene has also been used with PUVA but should be applied after UVA exposure because UVA can degrade the active molecule. Several new vitamin D analogs have been introduced. Maxacalcitol (25 μg/g) has compared favorably with calcipotriene (50 μg/g) in a once daily regimen. Tacalcitol, another synthetic analog of calcitriol, has also been used successfully for topical treatment.4 Direct comparisons of these new vitamin D analogs with calcipotriene in large controlled clinical trials are needed. Micanol, a recently approved …