Tazarotene cream in combination with betamethasone valerate foam for plaque-type psoriasis

Journal of Drugs in Dermatology, March-April, 2005 by Sunil S. Dhawan, Marianna L. Blyumin, Daniel J. Pearce, Steven R. Feldman

Discussion

Both of the topical agents investigated in this study, tazarotene (11) and BMV foam (12) are effective for the treatment of plaque psoriasis. The theory behind using betamethasone foam in combination with tazarotene for psoriasis is manifold: minimize the potential for skin irritation and atrophy and enhance efficacy by 1) using two drugs with differing mechanisms and 2) improving compliance. Tazarotene was found to be chemically compatible with a range of topical corticosteroids, which curtails a concern about its potential inactivation. (13)

There is a common belief that in order to control psoriasis, ointments lacking cosmetic appeal have to be used. It is also commonly believed that although topical retinoids may be effective for psoriasis, they must be applied in tandem with greasy ointments to avoid excessive dryness and skin irritation. The use of corticosteroid foam with tazarotene has not been previously documented and is a novel approach to combination therapy. Our data shows that the combination of tazarotene cream with betamethasone foam is effective. It is important to note that moisturizing with greasy ointments is not required to reduce the irritation linked with topical retinoids; most likely the anti-inflammatory effect of the BMV foam protected against this. The BMV foam is thought to have superb compliance as seen in patients' willingness to apply the foam regularly. (14) The cosmetic appeal of the BMV foam/tazarotene combination and the lack of irritation perhaps played a key role in fostering compliance with the resultant high efficacy that was seen.

There was excellent clinical response to the regimen used in this study although interpretation of case series data is obviously limited by the lack of a control group. There was also no blinding and there is the potential for investigator bias. Certainly a 12-week case series is not powered to adequately detect uncommon adverse events; however, irritation is commonly seen when topical tazarotene is used by itself, and this common event was not detected in our study. The authors recognize the need for a controlled trial to determine the full utility of the tazarotene/BMV foam regimen. An effective and pleasant combination regimen that uses a non-greasy corticosteroid foam along with a topical retinoid would certainly be appreciated by more that a few frustrated psoriasis patients.

Disclosure: This study was supported by a grant from Connetics Corporation. Dr. Feldman has received research, speaking and/or consulting support from Connetics.

References

1. Weinstein GD, Krueger GG, Lowe NJ, et al. Tazarotene gel, a new retinoid, for topical therapy of psoriasis: vehicle-controlled study of safety, efficacy, and duration of therapeutic effect. J Am Acad Dermatol. 1997;37:85-92.

2. Krueger GG, Drake LA, Elias PM, et al. The safety and efficacy of tazarotene gel, a topical acetylenic retinoid, in the treatment of psoriasis. Arch Dermatol. 1998;134:57-60.

3. Duvic M, Asano AT, Hager C, Mays S. The pathogenesis of psoriasis and the mechanism of action of tazarotene. J Am Acad Dermatol. 1998;39:S129-S133.