1 The pharmacist’s role: The rational use of topical steroidsZinc Code: UK/RET/0102/16b Date of Prep: November 2016 The pharmacist’s role: The rational use of topical steroids

2 Zinc Code: UK/RET/0120/16b Date of Prep: November 2016 Christine Eksteen Global Scientific Director for Dermatology at Stiefel, a GSK company Pharmacist by training, working in the pharmaceutical industry for the last 15 years and in Global Medical Affairs for dermatology over the last 3 years In Stiefel, she has been leading the Global Medical Affairs activities for acne, superficial skin infections, psoriasis, atopic dermatitis and androgenic alopecia

3 Webinar overview Introduction to atopic dermatitis (AD) and psoriasisZinc Code: UK/RET/0120/16b Date of Prep: November 2016 Webinar overview Introduction to atopic dermatitis (AD) and psoriasis Role of topical corticosteroids (TCS) in the treatment of AD and psoriasis Appropriate use and potential side effects of TCS Role of pharmacists in patient education Live Q&A

4 Introduction to atopic dermatitis (AD) and psoriasisZinc Code: UK/RET/0120/16b Date of Prep: November 2016  Introduction to atopic dermatitis (AD) and psoriasis There is a range of skin disorders that are responsive to topical corticosteroid therapy; for the purposes of this presentation, we will focus specifically on atopic dermatitis and psoriasis

5 About atopic dermatitis (AD)Zinc Code: UK/RET/0120/16b Date of Prep: November 2016 About atopic dermatitis (AD) Causes1 Common symptoms1 Impacts2 No known single cause Dry skin Itching Redness Reduced quality of life Genetic link Prevalence3 Emotional distress Affects at least 15% of children Affects 2–10% of adults Environmental factors Disturbed sleep AD can be mild, moderate or severe1 AD is a common condition, seen in up to 10% of adults,1 and can have a broad impact on patients’ quality of life beyond the symptoms themselves.2 The itching associated with AD can disturb patients’ sleep, and emotional impact can include embarrassment and loss of social confidence, as well as frustration and anger.2 References Kabashima K. J Dermatol Sci 2013; 70:3–11. Basra MK, et al. Expert Rev Pharmacoecon Outcomes Res 2009; 9(3): 1. NICE. Eczema – atopic. Clinical Knowledge Summaries 2015; Accessed September 2016; 2. Basra MK, et al. Expert Rev Pharmacoecon Outcomes Res 2009; 9(3):271–283; 3. Kabashima K. J Dermatol Sci 2013; 70:3–11.

7 Patches, papules or plaques Reduced quality of lifeZinc Code: UK/RET/0120/16b Date of Prep: November 2016 About psoriasis Causes Common symptoms2 Impacts2,3 Scaly skin lesions Itching Patches, papules or plaques Reduced quality of life Inappropriate immune response1 Flare triggers include: Psychological effects Prevalence Affects approximately 2% of the world’s population:4 nearly 150 million people worldwide5 Stress, trauma2 There are several forms of psoriasis, including plaque, pustular, nail, guttate, and erythrodermic2 Physical effects Environmental factors2 Psoriasis should normally be managed by a primary or secondary care physician, following appropriate referral2 Psoriasis is an autoimmune condition affecting tens of millions of people worldwide.1,2 Psychological and social effects of psoriasis may include:3 Anxiety and depression Negative body image and self image Shame, guilt, embarrassment, and fear of being considered dirty or infectious Limitation of activities, including those requiring skin exposure (such as swimming) and work Negative effect on social, professional, and personal relationships References Lowes MA, et al. Nature 2007; 445(7130): Bhosle MJ, et al. Health Qual Life Out 2006. NICE. Psoriasis. Clinical Knowledge Summaries 2014; Accessed September 2016; 1. Lowes MA, et al. Nature 2007; 445(7130):866–873; 2. NICE. Psoriasis. Clinical Knowledge Summaries 2014; Accessed September 2016; 3. Basra MK, et al. Expert Rev Pharmacoecon Outcomes Res 2009; 9(3):271–283; 4. Bhosle MJ, et al. Health Qual Life Out 2006; 4:35; 5. World population estimate: 7,450,000,000 (http://www.worldometers.info/world-population/, accessed 23 September 2016).

9 Zinc Code: UK/RET/0120/16b Date of Prep: November 2016 Psoriasis and AD are common disorders that impact patients’ quality of life AD is a common condition featuring dry, itchy and red skin1 Only mild AD can be treated over the counter – patients with more severe forms of the condition should be referred to their primary care physician1 Psoriasis is a debilitating disease with psychological and physical consequences;2,3 plaque psoriasis is by far the most common form2 Patients with psoriasis should be managed collaboratively by both their primary care physician and dermatologist with regard to assessing the impact of psoriasis and disease severity2 In addition to advice on using emollients, pharmacists can provide key practical support and guidance on TCS use, including how and where to apply the formulations. It is common for patients to be prescribed a selection of TCS with different potencies; therefore, it is important that they understand which therapy should be used where, and for how long. In case of any doubt, the patient should return to their HCP for further assessment and guidance. Doctor by ProSymbols, Noun Project 1. NICE. Eczema – atopic. Clinical Knowledge Summaries 2015; Accessed September 2016; 2 NICE. Psoriasis. Clinical Knowledge Summaries 2014; Accessed September 2016; 3. Basra MK, et al. Expert Rev Pharmacoecon Outcomes Res 2009; 9(3):