**3.1 Combination of basic blend and tailored blend topical moisturisers for the management of psoriasis**

The commonly used topical formulation blends, either basic or tailored (**Figure 5**), can provide efficacy through divergent pathways. As these formulation blends contain a unique combination of ingredients (Section 2) they can potentially act through different mechanisms. As a result, there is a scientific rationale for their use in the management of psoriasis, either individually or in combination. This rationale assumes that such formulation blends are selected on the basis of their individual mechanism of action and the biophysical effects they exert on psoriatic skin, which may offer the possibility of synergistic efficacy as well as a reduction in the occurrence of cosmetic problems and side effects (**Figure 6**) [99].

Topical moisturiser formulation blends and topical therapeutics with moisturising bases (**Figure 5**) can be used in a deliberate sequence individually or in combination

#### **Figure 5.**

*A range of basic blend and tailored blend topical moisturiser formulations: Lotions, gels, creams and ointments, each distinguished by its unique composition, ingredient combination, and cosmetic and/or therapeutic effects they exert on psoriatic skin, resulting in a range of skin benefits.*


### **Figure 6.**

*Efficacy, relapse rate, side effects and cosmetic problems associated with the use of basic blend moisturisers that contain no actives, tailored blend moisturisers that contain actives such as keratolytics and tar-based actives (coal tar and/or pine tar), and therapeutics with moisturising ingredients and actives such as corticosteroids in the management of psoriasis. Scored on a scale from zero (0) to three (3): 0 denotes little or no change/effect; 3 denotes great and frequent change/effect [102].*

(and even with other management options such as phototherapy and systemic medications) with the aim of achieving initial efficacy for the management of psoriasis followed by a safe maintenance regimen. This management strategy maximises the efficacy of each product while helping to minimise relapse rate, cosmetic problems and long term side effects (**Figure 6**) [99, 101, 102].

Now, when we are familiar with a range of basic blend and tailored blend topical moisturiser formulations and their unique composition and ingredient combination (as explained above) (**Figure 5**), an example of a management strategy for psoriasis would be as follows: first, the use of a topical therapeutic with a moisturising base

#### *Topical Moisturisers for the Management of Psoriasis Vulgaris DOI: http://dx.doi.org/10.5772/intechopen.101964*

containing a topical steroid potent enough for the severity of the disease (e.g., hydrocortisone for mild, mometasone furoate for moderate to severe) or pine-tar active, at the maximum therapeutic dose, with the main aim of promptly controlling psoriasis flare-ups accompanied by redness and inflammation. This first step can then be followed by the use of a topical moisturiser formulation blend in which a well-tolerated ingredient such as a keratolytic is introduced to reduce psoriatic plaque thickness and scaling. Finally, by using a cosmetically beneficial basic topical moisturiser formulation, the patient can remain indefinitely on a maintenance regimen that aims for continuous hydration of the skin as well as improvements in skin suppleness, flexibility and strength, and the minimisation of dryness and itchiness (**Figure 4**).

While moisturisers are important tools in the management of psoriasis, their use comes with some challenges such as patient perspectives [10] as described in Section 1.4, and some general and more specific concerns regarding the development, uses and regulations of novel anti-psoriatic topical formulations [99]. These include the following amongst many others: (1) heterogeneity in psoriatic plaque thickness, (2) management of psoriasis in different groups of patients (e.g., elderly, pregnant women, children, immuno-compromised patients) requires a few specific care factors and considerations (e.g., prolonged use of topical corticosteroids may lead to thinning of the skin in elderly patients) [10], (3) the safety and efficacy of novel moisturisers when used in combination with existing and established therapies [99] and (4) regulatory requirements and classifications of topical moisturisers, be they cosmetic or therapeutic [103, 104].
