Psoriasis is a chronic skin condition that affects more than 8 million Americans, according to the National Psoriasis Foundation. The disease arises from an abnormal immune response that triggers the rapid turnover of skin cells, causing them to pile up on the skin's surface. Most people have a form called plaque psoriasis, where they periodically develop red, scaly patches on the skin that can be itchy and painful. For Black people, who have higher melanin, psoriasis may appear as purple patches with gray scales or a dark brown color. For lighter skin Blacks, the patches may appear similar to those on white skin. The patches can also be more widespread on black skin making it harder to distinguish psoriasis from other conditions.
However, a cream medication that eases skin inflammation might offer a safer treatment option for people with psoriasis, a clinical trial suggests.
The study tested an experimental cream medication that may bypass the side effects of current topical treatments for psoriasis.
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 eight percent of those given an inactive ("placebo") cream.
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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, the most common skin treatment for psoriasis.
READ: Stronger Together: What Can a Dermatologist Do For Your Psoriasis?
High-potency steroids can be effective for the condition. But the downsides include thinning of the skin, changes in pigmentation and irreversible stretch marks, Dr. Mark Lebwohl, the lead researcher on the trial says.
That limits the drugs' use, he explained, especially on sensitive areas like the face.
Other options, like vitamin D analogues, don't work all that well and can irritate the skin, Lebwohl adds.
Meanwhile, there are systemic treatments for psoriasis, including various
injections and oral drugs. But they are usually reserved for more severe cases.
"The market has become crowded with systemic therapies," Lebwohl notes. "But most people have more moderate disease."
Among the oral medications is apremilast (Otezla), a pill that targets an inflammation-producing enzyme called PDE-4. Roflumilast, the new cream-based medication, is also a PDE-4 inhibitor.
Lebwohl says, it could offer patients an equally effective nonsteroid alternative, if it is approved by the U.S. Food and Drug Administration.
Dr. Lawrence Eichenfield, a dermatologist, agreed that a new topical option would be "welcome."
"It would be exciting to see an effective topical treatment for psoriasis that's also well-tolerated," Eichenfield says.
READ: Which Psoriasis Treatment Is Right For You?
The trial included 331 adults with plaque psoriasis, usually a moderate form. On average, the condition affected six percent of their skin surface.
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.
Within six weeks, 28 percent of patients on the higher dose had
clear or almost clear skin, as did 23 percent of those on the lower dose. That compared with eight percent of placebo users, according to the report.
By week 12, those rates were up to 38 percent and 32 percent in the two medication groups, and 16 perent in the placebo group. There were no signs the medication caused skin irritation, Lebwohl shares.
However, the study was only short-term. Lebwohl says a larger trial is underway, and it will test the cream over a longer period.
If that trial goes well and the drug is approved, a real-world hurdle could arise cost.
Topical corticosteroids are fairly cheap, and the new alternative would presumably be much pricier. "Ultimately, access will be an issue," Lebwohl says.
Eichenfield says he doubts topical corticosteroids would be abandoned -- not only because of cost, but because they have a long history of use.
For people with psoriasis, Eichenfield shares that it's important to be aware there are newer treatment options -- pills and, possibly, a topical medication on the horizon.
READ: Ten Ways To Prevent Psoriasis Flare-Ups
Other ways to improve Psoriasis treatment
If you are unsure of your condition, you should consult with your doctor. It also helps to pay close attention to how psoriasis appears on different skin colors. This can improve diagnosis and treatment.
You should also make lifestyle changes to the following to avoid a psoriasis flare-up:
- stress
- injury
- alcohol
- certain foods
- medications
- other infections
