Topical Treatments for Skin Disorders: Safe Alternatives to Steroids and NSAIDs
Inflammatory skin diseases can have a significant impact on self-esteem. Some even affect overall physical health. More than half of nearly 2,000 patients with rosacea reported that embarrassment over their skin made them avoid face-to-face contact, while psoriasis is associated with heart disease, diabetes and depression. Topical steroids are the go-to treatment, but they’re only used for a short time due to the risk of side effects. NSAIDs are an option, but they often irritate skin and aren’t suitable for everyone. Biologics and natural antioxidants are effective and safe alternative topical treatments for skin disorders such as atopic dermatitis and psoriasis.
Biologic Treatments Effective for Psoriasis and Atopic Dermatitis
Topical biologics are valuable options for sensitive skin, for patients who aren’t responding to first-line treatment, or those suffering adverse effects from topical steroids. The potential for biologics to improve the treatment of psoriasis makes a significant contribution considering that half of all patients are dissatisfied with their first-line treatment and up to 30 percent remain untreated.1 Lack of treatment has far-reaching implications because patients with psoriasis are at a higher risk for depression, psoriatic arthritis, chronic disease, and even premature death.
The biologics currently approved for topical use—tacrolimus and pimecrolimus—are immunosuppressive agents that inhibit calcineurin, which in turn prevent the release of inflammatory cytokines. Both are effective, but a review of controlled trials specific to tacrolimus reported that tacrolimus 0.1 percent was more effective than low-potency steroids and just as effective as mid-potency corticosteroids.2
Black box warning: In 2005, the FDA required the addition of a black box warning on calcineurin inhibitors due to cancer concerns. However, a review published in June 2013 found that the number of malignancies and lymphomas reported to the FDA was lower among patients exposed to topical calcineurin inhibitors than for the general population.3
Effectiveness and Safety of Biologics in Infants and Children
Eczema commonly occurs in children under the age of 10 and often requires ongoing treatment. Using topical steroids is risky for this group because the medication is easily absorbed through children’s immature skin barrier. Long-term treatment combined with increased absorption can lead to systemic side effects such as suppression of the hypothalamic-pituitary-adrenal axis and adrenal failure.4
Biologics are typically used as second-line treatment, but following a five-year study, a multi-national team of specialists suggests they should be considered for first-line treatment. The group compared treatment with pimecrolimus one percent cream plus short-term topical steroids used only for flare-ups to treatment with nothing but topical steroids. When used as a first-line treatment, pimecrolimus was safe, reduced the exposure to steroids, and proved to be as effective as steroids for mild to moderate atopic dermatitis in infants and children.5
Like adults, children have minimal risk of cancer from using topical calcineurin inhibitors, noted Jon M. Hanifin, MD in a discussion about the Pediatric Eczema Elective Registry (PEER). The registry began in 2004 and over 10 years reported two cases of leukemia, one osteosarcoma, two lymphomas and no skin cancers.6
Proactive roles for pharmacists:
- Talk to parents about the proper use of all topical products, stressing the importance of using the recommended dose to minimize systemic absorption.
- Take the opportunity to ask if parents are using other skin care products to maintain skin integrity. This opens the door to discussing compounded topicals, which can be individually formulated using emollient delivery bases.
The only antioxidants with proven efficacy in topical formulations are vitamin D analogues such as calcipotriol and calcipotriene. About 70 percent of patients treated with topical calcipotriene experienced significant improvement of their plaque psoriasis.7
Vitamins C and E, resveratrol, epigallocatechin gallate, and curcumin are just a few of the natural antioxidants with the potential to fight inflammation, reduce damage from ultraviolet-light-induced free radicals or boost collagen production when used in topical applications. As ingredients in cosmeceuticals, antioxidants may fight some signs of aging and protect the skin, but they must be carefully formulated to prevent degradation. More research is needed to determine their efficacy in dermatologic conditions.
Compounding Pharmacists are Reliable Resources
Whether they have a prescription to fill or they’re browsing the shelves for OTC products, patients with inflammatory skin disease can benefit from the expertise of compounding pharmacists. Some aren’t comfortable asking questions in the doctor’s office, so they may need more information about the safe use of topical skin treatments. Others would love to learn more about natural skin treatments customized for their problems. Either way, it’s important not to miss the opportunity to reach out and show individuals the advantage of tailored compounded products.
Pharmaceutica North America provides quality bulk pharmaceuticals and highly-penetrating, emollient delivery bases. Please contact us today to talk about how we can support your compounding pharmacy.
- “Undertreatment, Treatment Trends, and Treatment Dissatisfaction Among Patients With Psoriasis and Psoriatic Arthritis in the United States,” October 2013, http://archderm.jamanetwork.com/article.aspx?articleid=1729130 ↩
- “Guidelines of Care for Atopic Dermatitis,” July 2014, https://www.aad.org/file%20library/global%20navigation/education%20and%20quality%20care/ad-part-2.pdf ↩
- “Topical Calcineurin Inhibitors and Lymphoma Risk: Evidence Update with Implications for Daily Practice,” June 2013, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3669499/ ↩
- “Systemic Side-Effects of Topical Corticosteroids,” September 2014, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171913/ ↩
- “Safety and Efficacy of Pimecrolimus in Atopic Dermatitis: A 5-Year Randomized Trial,” March 2015, http://pediatrics.aappublications.org/content/early/2015/03/17/peds.2014-1990 ↩
- “A Reassuring Rejoinder Against Malignant Influences of Topical Calcineurin Use in Children,” June 2015, http://archderm.jamanetwork.com/article.aspx?articleid=211934 ↩
- “Psoriasis: Recommendations for Vitamin D Analogues,” 2015, https://www.aad.org/education/clinical-guidelines/psoriasis-guideline/topical-therapy/psoriasis-recommendations-for-vitamin-d-analogues ↩