Non-Invasive Evaluation of Tacalcitol Plus Puva versus Tacalcitol Plus UVB-NB in the Treatment of Psoriasis: “Right-Left Intra-Individual — Pre/Post Comparison Design”

Abstract

Photochemotherapy with psoralen plus ultraviolet A (pUVA) and phototherapy with UVB narrow band (UVB-NB) are used in the treatment of psoriasis. Numerous studies have shown that the additional administration of either topical or systemic antipsoriatic agents may effectively increase the efficacy of these therapies. This study aimed to compare through objective data the efficacy of topical tacalcitol in combination with PUVA or UVB-NB versus PUVA and UVB-NB monotherapy in the treatment of mild to moderate chronic plaque psoriasis. Modified Psoriasis Area and Severity Index (PAS!) score, transepidermal water loss (TEWL) and stratum corneum hydration were used to monitor the restoration of skin barrier in the psoriatic plaques of 40 patients during photochemotherapy. The study was a right-left, intra-individual, pre/post comparison trial. PUVA and UVB-NB treatments were given three times a week. On those plaques localized on the right side ofthe body tacalcitol ointment was applied once a day, in the evening. Corneometry, TEWL and modified PASI score were used to evaluate the response to the treatment at baseline, one month and two months. Thirty-six ofthe forty enrolled subjects completed the study. The comparison between combination treatments and the PUVAlUVB-NB monotherapy showed no significant differences with regard to modified PASI index. However, significant differences were recorded with regard to TEWL and corneometry. The combination oftacalcitol plus PUVA or tacalcitol plus UVB-NB restored epidermal barrier functions as well as skin hydration faster than PUVA or UVB-NB monotherapy (TEWL: p=O.0050 and corneometry: p=O.003). The combination of tacalcitol plus UVB-NB allowed a better restoration of skin barrier functions than tacalcitol plus PUVA (p=0.013). In conclusion, the combination of tacalcitol plus PUVA or plus UVB-NB improves the therapeutic result. In addition, the data from TEWL and skin hydration suggest a means in which tacalcitol plus UVB-NB induces a better normalization of skin biophysical parameters.Photochemotherapy with psoralen plus ultraviolet A (365nm) (PUVA) and phototherapy with UVB narrow band (311nm) (UVB-NB) are widely used in the treatment ofpsoriasis (1). Numerous studies have shown that the additional administration of topical or systemic antipsoriatic agents may serve as an effective means to increase the efficacy of these therapies and to reduce possible long term risks of cutaneous malignancies (2). Tacalcitol (1a.,24-dihydroxyvitamin D3) is a synthetic analogue of calcitriol, the most active metabolite of vitamin D (3). The biological action of tacalcitol includes the regulation of

The influence of psoriatic plaques pretreatment with crude coal tar vs. petrolatum on the efficacy of narrow‐band ultraviolet B: a half‐vs.‐half intra‐individual double‐blinded comparative study

“…Several studies have been conducted to enhance the outcome of phototherapy through skin pretreatment with specific topical preparations (3–23). In this context, tar and petrolatum were reported to enhance the outcome of NB‐UVB; nevertheless, some authors reported some potential drawbacks due to the physical properties of the preparation that may lead to screening rather than enhancement of UVR (5, 19, 23–25).…”

“…Trials were conducted on tar (3–5), anthralin (6), steroids (7), mineral oil, salicylic acid, petrolatum (5), calcipotriene (8, 9), and tazarotene (10). With the development of NB‐UVB, it represented a new target for combination trials with dithranol (11, 12), vitamin D derivatives (13–17), tazarotene (18), dithranol (14), petrolatum (19), oleic acid (20), mineral oil (21), saltwater (22), and tar (23). Although the outcome of these combinations was encouraging, the physical properties of the preparation, the thickness and/or the color of the film, represented a challenge to overcome the undesirable UV‐blocking effect (5, 24, 25).…”

S3 – Guidelines on the treatment of psoriasis vulgaris (English version). Update

“…Eight grade A2 studies [116, 118, 121, 124, 163–165, 172], nine grade B studies [130, 133, 136, 166, 168, 173–176], and three grade C studies [177–179] were included on combination therapy with vitamin D and other topical or systemic therapies. A general distinction may be made between topical combination therapy, combination drugs (i.e., different active ingredients in one preparation), and sequential combinations of different preparations (i.e., agents in two different preparations).…”

“…Two studies on combination therapy with tacalcitol ointment have been included in the guidelines. Brazzelli et al [174] (EG B) reported a significant change in trans‐epidermal water loss (TEWL) and on corneometry, but not on visual scores. In other words, in terms of visible lesions, an eight‐week regimen of tacalcitol with UV therapy does not appear to be superior to UV monotherapy.…”

S3 – Guidelines on the treatment of psoriasis vulgaris Update 2011

“…Yet a study on combination therapy with and calcitriol are roughly equally effective, it may be assumed that calcitriol therapy is more effective than tacalcitol 133,136,166,168,[173][174][175][176],. Use with salicylate-based keratolytics or dithranol preparations can diminish the effectiveness of the drug.…”