Psoriasis and Atopic Dermatitis “Resistant” to Topical Treatment Responds Rapidly to Topical Desoximetasone Spray

Abstract

Purpose: Topical corticosteroids (TS) are a treatment for atopic dermatitis (AD) and psoriasis (Ps). We assessed whether use of a TS under conditions designed to enhance adherence would be effective in patients who “failed” TS in the outpatient setting. Methods: Individuals with treatment-resistant Ps or AD were recruited (AD, n = 12; Ps, n = 12). Six participants were randomized to each of 2 groups of desoximetasone 0.25% spray alone (n = 6) or desoximetasone spray plus twice-daily phone call reminders to use the medication. Disease severity was assessed. Results: In treatment-resistant Ps patients, desoximetasone spray, with reminders, resulted in statistically significant improvement in all outcome measures. In treatment-resistant AD patients, there was statistically significant improvement in some assessments. Despite the very small sample size and short evaluation time, statistically significant changes were detected in this cohort. This is evidence of the large effect size of TS for Ps and AD when the treatment is used. Conclusions: Patients with “treatment-resistant” Ps and AD generally responded well to the use of desoximetasone spray in the trial setting. This may be due to better adherence in the study environment or patients’ preference for the spray vehicle. Patient reminders contributed to improved clinical outcomes in Ps and AD patients with “treatment-resistant” disease.

Refractory Pediatric Psoriasis and Atopic Dermatitis: The Importance of Therapeutical Adherence and Biological Management

“…Twelve "topical steroid resistant" psoriasis patients treated with 0.25% desoximetasone spray received either twice-daily phone call reminders or no reminders over two weeks [16]. Patients in the reminded group demonstrated improvement in their Pruritus Visual Analog Scale (VAS), PASI, Total Lesion Severity Score (TLSS), and Investigator Global Assessment (IGA) scores [4]. Similar studies evaluating the effect of twice daily phone reminders on symptom severity were completed with "topical corticosteroid resistant" AD patients [4,17].…”

“…Patients in the reminded group demonstrated improvement in their Pruritus Visual Analog Scale (VAS), PASI, Total Lesion Severity Score (TLSS), and Investigator Global Assessment (IGA) scores [4]. Similar studies evaluating the effect of twice daily phone reminders on symptom severity were completed with "topical corticosteroid resistant" AD patients [4,17]. Those who received reminders showed significantly greater mean improvement in their Eczema Area and Severity Index (EASI), TLSS, and IGA scores by the third visit, as compared to those who did not receive reminders [4,17].…”

“…Topical corticosteroids are commonly used to treat both AD and psoriasis, but many patients develop "resistance" over time [4]. Topical steroids are usually associated with vitamin D derivatives in the management of psoriasis [5].…”

“…Topical steroids are usually associated with vitamin D derivatives in the management of psoriasis [5]. In theory, resistance can be caused by a downregulation of target receptors due to chronic drug exposure; however, downregulation of target receptors has not been demonstrated in a clinical setting [4]. Reduced medication adherence may play a greater role in the development of resistant disease in this patient population as compared to the downregulation of target receptors [4].…”

“…In theory, resistance can be caused by a downregulation of target receptors due to chronic drug exposure; however, downregulation of target receptors has not been demonstrated in a clinical setting [4]. Reduced medication adherence may play a greater role in the development of resistant disease in this patient population as compared to the downregulation of target receptors [4]. This manuscript will explore the causes of resistant AD and psoriasis, as well as management options.…”