The role of topical therapy for patients with extensive psoriasis

Approximately 14% of patients with psoriasis have moderate or severe disease defined as affecting 3% to 10%, or greater than 10%, of body surface area (BSA), respectively. In the context of topical therapy, extensive disease refers to psoriasis involving 10% to 30% of BSA for which topical therapy might not have been considered optimum in the past because of patient preference and/or convenience. Treatment of patients with extensive disease traditionally has focused on phototherapy and/or systemic therapy with agents such as cyclosporine, methotrexate, and oral retinoids; these agents can improve outcomes in patients beyond those afforded by traditional topical monotherapy. Biologic therapy (e.g., alefacept, efalizumab, etanercept) provides dermatologists with additional treatment options for patients with extensive psoriasis, for whom topical treatments typically have been considered adjunct therapy for focal resistant lesions. A new 2-compound topical ointment containing calcipotriene 0.005% and betamethasone dipropionate 0.064% has demonstrated efficacy in patients with severe psoriasis, an outcome that previously was difficult to achieve with topical therapy. Advantages of the 2-compound ointment include rapid onset of action and a relative lack of systemic toxicity. This effective topical agent may expand the psoriasis population that can be considered candidates for topical treatment.