Magan Medical Clinic, Dermatology
We provide quality dermatology care with compassion. Our specialty is medical dermatology, including:
Note: Cosmetic treatments are not performed in Dermatology but instead by Magan's Medical Aesthetics Laser Center.
If you have psoriasis or hair questions, Dr. Chiang possesses special expertise. He completed fellowships in both fields at University of California, San Francisco where he saw a wide spectrum of patients (including the most severe), performed clinical trials, and published research.
We take pleasure in serving our community including Covina, West Covina, San Dimas, Rancho Cucamonga, Baldwin Park, Azusa, Glendora, Upland, El Monte, Duarte, Monrovia, Arcadia, La Puente, and Diamond Bar.
Same day appointments often available. No referral is necessary if you have PPO insurance. We accept a wide range of insurance plans (unfortunately, we do not accept Medi-Cal as primary insurance, only as secondary insurance).
For appointments, please call (626) 251-1500. We look forward to serving you!
"What's New in..."
A monthly column by Dr. Chiang
What's New in Psoriasis
The first line therapy for many skin conditions, especially psoriasis, are corticosteroid ("steroid") creams and ointments. Patients often ask how long they can use a mediation for. The FDA label for many steroid creams vary between 2 weeks, 4 weeks, and rarely longer. One of the strongest steroid creams for psoriasis is clobetasol cream. However, the official FDA product insert states "treatment beyond 2 consecutive weeks is not recommended" for most patients and even those with moderate to severe psoriasis are advised "can be used up to 4 consecutive weeks." There are no FDA guidelines on how long of a break should occur prior to restarting the medication. Having been a Psoriasis Fellow at UCSF, I would say from experience a patient with moderate to severe psoriasis with active plaques often flares if they take any break, much less a long-term break. I have seen many patients take substantial breaks due to their concern for steroid cream related side effects. Unfortunately, they often flared into severe disease and sometimes required either time-intensive treatments (phototherapy twice weekly) or higher risk systemic medications (oral or injectable).
An improvement is a new steroid that is now FDA approved for 8 weeks called halobetasol lotion 0.01%. Unfortunately, as a new medication it is only available as brand name Bryhali lotion. There were 2 clinical trials, totaling 430 subjects. There was no permanent hypothalamic-pituitary-adrenal axis ("hormone") suppression. There were about 1-2% of patients having an upper respiratory infection, application site rash, or elevated sugars. Drawbacks are that it is likely weaker than the generic halobetasol 0.05% cream, with only about 40% of patients experiencing treatment success, defined as "clear" or "almost clear" skin. To my knowledge, the strength (corticosteroid category) has not yet been reported, but it will likely be a class II (2nd strongest) or less medication versus the commonly used class I (strongest) steroid creams that are often used for psoriasis. Also, to my knowledge, the price has not yet been released. I wouldn't be surprised for it to cost insurance companies hundreds of dollars to cover. This would likely result in a high chance of insurance rejection.
Nevertheless, the information is useful in at least having FDA backing for 8 weeks of steroid cream safety for at least one product. Data has been lacking as steroid cream clinical trials are not common. Many of these medications have either been grandfathered in before today's more intensive testing, not had the funding for a long clinical trial, or the manufacturers did not wish to spend the money if the FDA did not require longer testing. It is quite possible that there are other steroid creams that are safe and effective for 8 weeks or longer, but the hard data is unfortunately not available.
Thus, we are practically left with physician experience to guide how to use the steroid creams and ointments. Given that psoriasis is often life long, many patients require steroid creams for months or years. Breaks are dependent on how a patient does, how careful they are to correctly apply the medication only on the rashes and not normal skin, and whether any side effects are seen. I do recommend periodic follow-up visits for evaluation for side effects. Systemic side effects have been extremely rare in adults. However, there can be skin side effects such as skin thinning, especially in patients who do not regularly see their doctor.
If you have psoriasis or other skin condition, consider making an appointment for dermatology consultation at (626) 251-1500 to discuss your options.
Charles Chiang, MD, FAAD
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