Optimizing Patient Communication and Treatment Efficacy Beyond Topical Steroids

"We had a great discussion around emphasizing different points of communication with patients to make sure that we have the best treatment options for those individuals, and then with these new novel treatments that come to us in practice, what is the best way to educate not only ourselves but our peers in these new treatment options to help better treat our patients,” said Omar Noor, MD, FAAD, during a recent Dermatology Times Case-Based Peer Perspectives custom video series, “Patient-Centered Approaches to Plaque Psoriasis: Advancements in Topical Therapies Beyond Steroids.”

Noor, a board-certified dermatologist and co-owner of Rao Dermatology in New York, New York, hosted a live Case-Based Roundtable discussion with local dermatology clinicians to discuss 2 patients with plaque psoriasis and what would be the ideal treatment for each.

Case 1: Inadequate Response to Corticosteroids

The first patient was a 55-year-old man with a 15-year history of plaque psoriasis treated with topical corticosteroids and vitamin D analogs. The patient had not had an adequate response to either. Noor and the attendees first discussed the pros and cons of increasing the potency of the patient’s topical corticosteroid and decided that tapinarof cream (Vtama; Dermavant) would be a better option.

“The 2 main thought processes were, as expected, efficacy and safety. But interestingly, efficacy was placed above safety in that everyone felt that if a medication doesn’t work, it doesn’t matter if it’s the safest medication or the most tolerable, it’s not something that we’re going to reach for for our patients,” Noor said.

Other highlights of the roundtable discussion included using proper communication and setting realistic expectations with patients. Noor noted that it is crucial to properly educate patients about nonsteroidal topicals, especially when they are used to long-term therapy with topical corticosteroids.

Approximately half of the participants believed that topical corticosteroids work the quickest and that patients would need to be informed that nonsteroidals such as tapinarof cream may take slightly longer. The other half of the group thought that tapinarof cream works just as quickly as topical corticosteroids.

Regarding the emphasis on nonsteroidal drugs, Noor stressed that with tapinarof cream, clinicians don’t have to worry about atrophy in their patients or the risks associated with applying topical corticosteroids to sensitive skin areas. Overall, tapinarof cream was selected as the best treatment option for this patient.

Case 2: Treatment Options for the Scalp

The second case Noor presented was a patient with plaque psoriasis on the scalp. Previously, the patient had been prescribed tacrolimus ointment, which was ineffective and difficult to work into the scalp. Noor and attendees discussed how the scalp is often one of the most common areas for plaque psoriasis, yet treatment options remain limited. Clinicians commonly prescribe a clobetasol solution, however, patients often experience a burning sensation, they noted. During the roundtable discussion, many of the attendees had not prescribed tapinarof cream for head and neck psoriasis because they were not familiar with the latest data.

Noor stressed the importance of clearly communicating to patients how to use tapinarof cream on the scalp, especially when considering different hairstyles, ethnicities, and cultural practices. One attendee who was familiar with tapinarof cream shared that she instructs patients with thicker hair to part their hair in numerous sections after they shower and apply tapinarof cream in the parts around each section.

Regarding the benefits of tapinarof cream for plaque psoriasis, the attendees noted that application is only needed once a day, which simplifies patients’ routines. Noor also stressed the importance of nonsteroidal creams replacing the frequent use of topical corticosteroids due to corticosteroid usage leading to hypopigmentation in patients with skin of color. In this case, tapinarof cream was selected as the best treatment option.

The final part of the roundtable discussion focused on the remittive effect of tapinarof cream in plaque psoriasis.

“I tell my patients that if we use this topical and you get clear, on average, you’re going to stay clear for 4 months off of the medication. Because everyone’s first question when you put them on any medication is when can they come off of it. We have the data. We have this term of remittive effect. Everyone [at the discussion] felt comfortable and has actually utilized that specific component of tapinarof data to communicate with our patients that, ‘Yes, if you get better and when you get better, you will stay better off of it,’” Noor said.