CHICAGO — A topical coal-tar solution that doesn't smell, a user-friendly hydrogel patch, and supraerythemogenic phototherapy were among the innovative approaches to psoriasis discussed at the American Academy of Dermatology Academy's 2008 meeting.
The NeoStrata Co. has launched Psorent, a steroid-free topical coal-tar solution that uses a novel, lightly occlusive liquid wax vehicle to reduce the odor and staining that caused traditional coal-tar solutions to fall out of favor. It contains 15% liquor carbonis distillate, equivalent to 2.3% coal tar, is available without a prescription, and features a dab-on applicator that avoids touching the solution or plaques.
In an ongoing NeoStrata-supported trial of patients with moderate plaque psoriasis, significantly more patients (30% of 23) randomized to twice-daily Psorent had at least a 75% reduction in Psoriasis Area and Severity Index (PASI) scores at 12 weeks, compared with none of the 25 patients randomized to twice-daily calcipotriol cream 0.005% (Dovonex).
Patients rated Psorent as “very easy” or “extremely easy” to use and its scent and staining near neutral. Treatment-related adverse events were comparable for both groups, according to interim results for 48 patients reported in a poster by principal investigator Dr. Alexandra B. Kimball of Massachusetts General and Brigham and Women's hospitals, Boston, and associates.
In a psoriasis symposium at the meeting, Dr. Jerry Bagel discussed a second study comparing narrow-band UVB phototherapy three times a week for 12 weeks plus twice-daily Psorent or placebo. At week 4, 75% of patients treated with Psorent plus phototherapy were clear or almost clear, whereas it took 7 weeks to clear with placebo plus phototherapy.
“This may be an effective modality to add on to phototherapy to decrease the amount of treatments, co-pays, and now the cost of driving to psoriasis centers,” said Dr. Bagel, a dermatologist in private practice in East Windsor, N.J.
Dr. John Koo said the Envela (Teikoku Pharma USA Inc.) hydrogel occlusion patch might finally make occlusion therapy feasible for psoriasis.
The dressing is composed of a hydrogel layer on a very thin and flexible, skin-colored, gas- and water-impermeable urethane backing. Unlike other patches, Saran wrap, or tapes, Envela appears to be both reasonably priced and user friendly, he said.
In an open-label study in 120 patients with mild to severe plaque psoriasis, twice-daily dressing with Envela alone produced some improvements, but noticeably enhanced efficacy and penetration when combined with hydrocortisone 1% cream, tacrolimus, and halobetasol, said Dr. Koo, professor and director of the Psoriasis and Skin Treatment Center, University of California, San Francisco.
Although the treatment was recently approved by the U.S. Food and Drug Administration, Envela's launch has been delayed for internal reasons, Ms. Mia Maslanka of Teikoku product development said in an interview.
Dr. Koo also discussed the potential of supraerythemogenic phototherapy. Traditional phototherapy is limited by its ability to deliver only a minimal erythema dose (MED) to avoid burning healthy skin at the margins of psoriasis. Supraerythemogenic phototherapy uses fiber optic-targeted application of narrow-band UVB to deliver many times the MED to plaques in a single treatment session. This makes phototherapy more aggressive, but healthy skin is spared because the application targets only plaques, which are more tolerant to high-dose UVB and don't burn, he said.
Patients might be cleared in only 10 treatments instead of the traditional 30–40 treatments, making phototherapy much easier to do, Dr. Koo added.
Dr. Kimball is a study investigator for Psorent and has participated in an advisory board meeting for NeoStrata. Dr. Bagel had no conflicts of interest in regards to Psorent. Dr. Koo has been an investigator for Teikoku but was not compensated.
An abdominal psoriatic plaque is shown at baseline (left) and after 4 weeks (middle) and 12 weeks of twice daily treatment with topical Psorent solution. Photos courtesy Dr. Alexa B. Kimball
