Journal of Clinical and Aesthetic Dermatology

MAY 2018

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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27 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY May 2018 • Volume 11 • Number 5 O R I G I N A L R E S E A R C H P Psoriasis is a chronic immunological disease characterized by infiltration of the skin with activated T-cells and by abnormal keratinocyte proliferation and differentiation, resulting in marked inflammation and thickening of the epidermis. Psoriasis affects 1 to 3 percent of the world's population, making it one of the most prevalent inflammatory immunological diseases. It is a disabling disease, and the impact it can have on quality of life is often underestimated by healthcare providers. 1 There are several clinical subtypes of psoriasis, with the most common being plaque psoriasis, affecting 75 to 80 percent of patients with psoriasis. 2 Plaque psoriasis is characterized by epidermal hyperproliferation and inflammation of the epidermis and dermis. Clinically, it presents as raised silvery scales with underlying erythema, itching, and discomfort. Plaques might affect large areas of the skin and have a significant psychosocial impact on the lives of patients. The scalp is one of the most common sites of psoriasis, often presenting at disease onset and continuing throughout the course of the disease. 3 An estimated 50 to 80 percent of patients with psoriasis have scalp involvement. 4 Psoriasis of the scalp is highly visible and has been found to have an outsized impact on the quality of life (QOL) of patients, even when only a small amount of body surface area (BSA) is affected. Visible plaques can affect self-esteem and negatively impact the ability of patients to socialize normally. 3 The condition can appear as only localized scales or can manifest as widespread, hyperkeratotic plaques. Scales can extend visibly beyond the hair margins and involve the face, neck, and ears. Patients with scalp involvement might experience intense itching. 5 Furthermore, topical therapies used to treat psoriasis can affect the cosmetic appearance of the hair. Application of topical therapy, along with the patient itch-and-scratch cycle, can produce a perpetual koebnerization that could perpetuate disease activity. 3 Another issue for patients is being able to correctly apply topical therapies so as to bypass the hair. Taken together, these factors might affect adherence and efficacy of treatment. Topical therapy of scalp psoriasis has been shown to improve QOL outcomes. 6 It has been suggested that newer vehicles, including sprays and foams, are the most appropriate methods for scalp medication application because they are less messy and are better able to penetrate to the scalp through the hair. 5 It has recently been shown that patients with plaque psoriasis prefer sprays more than 2 to 1 over creams, ointments, lotions, gels, and foams. 7 In this report, we present the findings of an open-label, observational study evaluating the efficacy, tolerability, and patient satisfaction of desoximetasone 0.25% spray (Topicort® Spray 0.25%; Taro Pharmaceuticals, Inc., Hawthorne, New York) in the treatment of psoriasis of the scalp. Desoximetasone spray 0.25% is a Class I, super-potent corticosteroid that has been shown to provide rapid and effective relief of scaling in plaque psoriasis. 7 It is the first super-potent formulation of desoximetasone. 8 The use of a spray A B S T R A C T Objective: The goal of this study was to evaluate efficacy and safety of desoximetasone spray 0.25%, a topical corticosteroid, in the management of scalp and body psoriasis. Design: This was an open-label, observational study. Participants: Twenty adults aged 18 years or older with chronic scalp psoriasis present on at least 30 percent of the scalp surface area and an Investigator Global Assessment (IGA) scale score of scalp disease of at least 2 on a scale of 0 to 4 were included in the study. Measurements: Study spray was applied twice daily for four weeks, followed by 12 weeks of twice-daily application for two consecutive days weekly. Results: At Week 4, the mean Physician Global Assessment (PGA) scale score had decreased 54.8 percent, from moderate disease to almost clear. Body surface area (BSA) had decreased by 51.2 percent, BSA × PGA had decreased by 63 percent, and scalp IGA had decreased by 64.5 percent from moderate to almost clear. Additionally, mean Psoriasis Scalp Severity Index (PSSI) score was 27.3±10.0 at baseline and decreased 82.4 percent to 4.8±5.2 and scalp surface area (SSA) was reduced by 70.7 percent at Week 4. The initial Scalp Index score was a mean of 65.7±15.0 at baseline and was reduced by 44.3 percent and 40.8 percent at Weeks 4 and 16, respectively. The initial response was maintained after a change to twice-weekly, twice- daily dosing, with a 48.4-percent decrease in PGA, a 17.1-percent decrease in BSA, a 31.5-percent decrease in BSA × PGA, a 51.6-percent decrease in scalp IGA, a 63.4 percent decrease in PSSI, and a 42.3-percent decrease in SSA seen at Week 16. Minimal adverse events were experienced by seven subjects. Conclusion: Desoximetasone spray 0.25% produced rapid improvements in PGA, BSA, BSA×PGA, scalp IGA, PSSI, SSA. KEYWORDS: Psoriasis, desoximetasone, topical corticosteroid, Scalpdex, body surface area An Open-label, Observational Study Evaluating Desoximetasone Topical Spray 0.25% in Patients with Scalp Psoriasis by JERRY BAGEL, MD, MS, and ELISE NELSON, LPN, CCRC Both authors are with the Psoriasis Treatment Center of Central New Jersey in East Windsor, New Jersey. J Clin Aesthet Dermatol. 2018;11(5):27–29 FUNDING: This study was sponsored by Taro Pharmaceuticals U.S.A., Inc. DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article. CORRESPONDENCE: Jerry Bagel, MD, MS; Email: dreamacres1@aol.com

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