As many of you know, topical corticosteroids are currently the mainstay for therapy in the treatment of plaque psoriasis. However, the downside of such treatment is that prolonged use can lead to tolerance, as well as adverse effects. To overcome this issue, now there is a new topical lotion called Duobrii which incorporates two ingredients: halobetasol propionate (high potency corticosteroid) and tazarotene (retinoid).
In the past, topical retinoids were not indicated for plaque psoriasis. However, in this combination product, halobetasol and tazarotene work together to relieve inflammation, reduce itching and decrease proliferation. The theoretical advantage of tazarotene is a steroid-sparing effect, meaning patients can use less halobetasol. The result is less systemic exposure of steroids and possibly allowing for a longer length of use. There are safety studies supporting use for up to one year.
Duobrii is applied to the affected areas once daily as a thin layer. Patient should not apply to broken skin, thin areas or use occlusive dressings. Because it is a high-potency product, patients should not use more than 50 grams per week due to risk of systemic absorption and suppression of the HPA axis, especially in the elderly. Some patients using for more than 8 weeks may need surveillance via bloodwork.
The most common adverse effects include contact dermatitis, peeling, redness, striae, telangiectasias, dryness, burning, possible photosensitivity and folliculitis. Also, it is important to remember that It is contraindicated in pregnancy.