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By Amy Norton<\/b>
HealthDay Reporter<\/i><\/p>\n
THURSDAY, July 16, 2020<\/p>\n
A cream medication that eases skin inflammation<\/a> might offer a safer treatment option for people with psoriasis<\/a>, a new clinical trial suggests.<\/p>\n Psoriasis<\/a> is a chronic skin condition that affects more than 8 million Americans, according to the National Psoriasis<\/a> Foundation. The disease arises from an abnormal immune response that triggers rapid turnover of skin cells, causing them to pile up on the skin’s surface.<\/p>\n Most people have a form called plaque psoriasis<\/a>, where they periodically develop red, scaly patches on the skin that can be itchy<\/a> and painful.<\/p>\n The new study tested an experimental cream medication that may bypass the side effects of current topical treatments for psoriasis<\/a>.<\/p>\n The cream contains a drug called roflumilast, which blocks an inflammation-producing enzyme. The researchers found that among patients randomly assigned to use the cream once a day, roughly one-quarter saw their skin clear up within six weeks. That compared with 8% of those given an inactive (“placebo”) cream.<\/p>\n Experts called the results “exciting” — in large part because the treatment is not expected to cause the side effects that can come with topical corticosteroids<\/a>, the most common skin treatment for psoriasis<\/a>.<\/p>\n High-potency steroids can be effective for the condition. But the downsides include thinning of the skin, changes in pigmentation and irreversible stretch marks<\/a>, said Dr. Mark Lebwohl, the lead researcher on the trial.<\/p>\n That limits the drugs<\/a>‘ use, he explained, especially on sensitive areas like the face.<\/p>\n Other options, like vitamin D<\/a> analogues, don’t work all that well and can irritate the skin, said Lebwohl, chair of dermatology at Mount Sinai’s Icahn School of Medicine in New York City.<\/p>\n Meanwhile, there are systemic treatments for psoriasis<\/a>, including various injection and oral drugs<\/a>. But they are usually reserved for more severe cases.<\/p>\n “The market has become crowded with systemic therapies,” Lebwohl said. “But most people have more moderate disease.”<\/p>\n Among the oral medications is apremilast<\/a> (Otezla<\/a>), a pill that targets an inflammation-producing enzyme called PDE-4. Roflumilast, the new cream-based medication, is also a PDE-4 inhibitor.<\/p>\n And, Lebwohl said, it could offer patients an equally effective nonsteroid alternative — if it is approved by the U.S. Food and Drug Administration.<\/p>\n Dr. Lawrence Eichenfield, a dermatologist who was not involved in the study, agreed that a new topical option would be “welcome.”<\/p>\n “It would be exciting to see an effective topical treatment for psoriasis<\/a> that’s also well-tolerated,” said Eichenfield. He’s a professor of dermatology at the University of California, San Diego, and member of the American Academy of Dermatology.<\/p>\n The study results were published July 15 in the New England Journal of Medicine<\/i>.<\/p>\n The trial included 331 adults with plaque psoriasis, usually a moderate form. On average, the condition affected 6% of their skin surface.<\/p>\n Patients were randomly assigned to one of three groups: Two used the roflumilast cream once a day, at either a lower or higher dose. The third used a placebo cream.<\/p>\n Within six weeks, 28% of patients on the higher dose had clear or almost-clear skin, as did 23% of those on the lower dose. That compared with 8% of placebo users, according to the report.<\/p>\n By week 12, those rates were up to 38% and 32% in the two medication groups, and 16% in the placebo group. There were no signs the medication caused skin irritation, Lebwohl said.<\/p>\n However, the study was only short term. Lebwohl said a larger trial is under way, and it will test the cream over a longer period.<\/p>\n If that trial goes well and the drug is approved, a real-world hurdle could arise: cost.<\/p>\n Topical corticosteroids<\/a> are fairly cheap, and the new alternative would presumably be much pricier. “Ultimately, access will be an issue,” Lebwohl said.<\/p>\n Eichenfield said he doubted topical corticosteroids<\/a> would be abandoned — not only because of cost, but because they have a long history of use.<\/p>\n For people with psoriasis, Eichenfield said, it’s important to be aware there are newer treatment options — pills and, possibly, a topical medication on the horizon.<\/p>\n The trial was funded by Arcutis Biotherapeutics, which is developing the drug. Lebwohl has received consulting fees from the company.<\/p>\n ![\"MedicalNews\"](\"https:\/\/images.medicinenet.com\/images\/HealthDay\/healthday.png\")
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