Dr. Marni C. Wiseman
Dr. Marni C. Wiseman began her Dermatology practice in Winnipeg, Manitoba in 2001. In addition to her responsibilities as an Associate Professor and Section Head of Dermatology at the Faculty of Medicine at the University of Manitoba, Dr. Wiseman spends most of her days at her Private Medical Practice as the Medical Director of SKiNWISE DERMATOLOGY.
Dr. Wiseman’s areas of clinical and research interest include psoriasis, atopic dermatitis, hidradenitis suppuritiva, acne, and aesthetic dermatology. She is a Principal Investigator at Wiseman Dermatology Research and has participated in hundreds of clinical trials.
Dr. Wiseman is a frequent supervisor and mentor for medical students and residents. She is extensively published in areas of inflammatory skin disease, photodermatosis, and cutaneous malignancy.
Dr. Wiseman’s community commitments are extensive and include involvement with the Canadian Dermatology Association Sun Awareness program. She is an editor of the Journal of Cutaneous Medicine and Surgery, and was the chair of the Skin Cancer Disease Site Group at CancerCare Manitoba for 15 years. Dr. Wiseman holds regular outreach skin cancer screening clinics in rural locations in Manitoba, has been featured in many news stories, and regularly presents at meetings and congresses nationally and internationally.
Saturday NOV 26, 2022
Pso Let’s Talk: “The Trouble with Topicals"
Chronic plaque psoriasis (PsO) is an auto-immune mediated inflammatory skin diseases that varies in severity affecting over 1 million people in Canada.1 The majority of patients present with mild to moderate disease as determined by objective measures used by clinicians, but it is increasingly recognized, disease severity experienced by the patient is more than just a body surface area or PASI score calculation as evidenced by decreased quality of life and higher risks for depression, anxiety and suicide.1,2,3 Although topical corticosteroids (TCSs) remain the foundation of treatment and are used across the spectrum of plaque PsO, there has been a paucity of clinical innovation in comparison to the advances in biologic therapies made in the past decade.3,4
Despite good treatment responses with TCSs, they can be limited for long-term use due to local (e.g., stria, skin atrophy, and telangiectasia) or systemic (e.g., hypothalamic-pituitary-adrenal [HPA] axis suppression) adverse events (AEs).5 Topical retinoids and vitamin D analogs, originally introduced in the latter part of the 20th century, have their own troublesome AEs with skin irritation (e.g., redness, itching, stinging or burning, peeling and dryness) as a common cause for a patients’ dissatisfaction and/or lack of adherence.3,5 Topical calcineurin inhibitors and the only currently available topical phosphodiesterase- 4 inhibitor in Canada, are indicated for atopic dermatitis, but have been used for PsO with some success in the sensitive intertriginous and facial areas.6 There is limited access for these latter drugs depending on patients’ private insurance coverage.
PsO is a heterogeneous disease with varied clinical presentations with almost 90% of patients experiencing PsO in more than one location.4,6 Due to the limitations of today’s topical armamentarium, dermatologists often need to prescribe during one patient visit 2 or 3 different topicals of varying potencies and/or formulations. This can be troublesome for patients as they tend to forget or misunderstood the instructions provided by their dermatologist which can be confounded by further troubling instructions from the dispensing pharmacist.3,4 As such, the trouble with topicals today remains and there continues a large unmet need to develop a simplified regimen that is better tolerated with a cosmetically pleasing formulation which is steroid-sparing yet has a fast onset of action with an effectiveness comparable to mid-high potency TCSs. The trek towards this goal will be explored as new developments in topical non-steroid therapy will be presented.