Topical corticosteroids in plaque psoriasis: a systematic review of efficacy and treatment modalities

Abstract

The clinical development of topical steroids in psoriasis did not follow state of the art modern methodology. Treatment success appears to be highly variable across studies. Maintenance intermittent treatment appears to be useful to prolong remission. Recommendations concerning topical steroids treatment modalities in plaque psoriasis should be mostly based on expert opinion.

Mechanisms of Action of Topical Corticosteroids in Psoriasis

“…To overcome the variable nature of the disease and also the several options of treatment, there are currently two sets of guidelines from Germany [22] and USA [6] available for the different forms of topical treatment, which allow = a more effective therapy decision and to decide when patients move from topical to systemic treatment [7]. However, there are huge differences between recommendations from different countries [7, 9]. While German guidelines [22] recommend a combination of topical steroids with salicylic acid (broad combination is possible; care must be taken regarding steroid side effects), USA guidelines [6] suggest the use of topical steroids as monotherapy in mild-to-moderate psoriasis or in combination with other topical agents, UV light or systemic agents in moderate-to-severe disease [7].…”

“…Since their introduction to dermatology, more than 50 years ago, topical corticosteroids have become the mainstay of treatment of various dermatoses including psoriasis, mainly due to their immunosuppressive, anti-inflammatory and antiproliferative properties, which makes this class of drugs an useful therapy for this immune-mediated disease [9, 10]. …”

Evidence‐based recommendations on topical treatment and phototherapy of psoriasis: systematic review and expert opinion of a panel of dermatologists

“…The frequency of non‐adherence to topical agents and the strategies to improve adherence were also investigated. The results of the systematic reviews are presented along with the present article 9–15 . As a second step, a group of dermatologists with special interest in psoriasis care were consulted to formulate recommendations relevant to clinical practice according to a methodology described previously 16,17 …”

Dimethyl Fumarate Modulation of Immune and Antioxidant Responses: Application to HIV Therapy

“…Current models now incorporate an inflammatory axis that balances the Th1, Th2, Th17, and T-regulatory type responses as well as contributions by dendritic cells, natural killer T-lymphocytes, and macrophages (reviewed in 80 ). Underscoring this central role of inflammation in the pathogenesis of psoriasis, numerous immunomodulatory therapies have shown efficacy in treating psoriasis, including corticosteroids, 81 tacrolimus, 82 pimecrolimus, 83 methotrexate, 84 and the TNFα inhibiting therapies etanercept, 85 infliximab, 86 and adalimumab. 87 …”

“…Evidence for this includes reports demonstrating that myelin abnormalities might begin at the inner myelin sheath in areas outside focal inflammation; 114, 115 patients in early stages of multiple sclerosis show little evidence of T-lymphocyte or B-lymphocyte infiltration in newly formed demyelinating lesions (although evidence of the innate immune response by macrophage infiltration and microglial activation is present, probably for clearing debris); 116, 117 and the ineffectiveness of autologous hematopoietic stem-cell transplantation to halt the progression of demyelination, axonal degeneration, and brain atrophy despite reducing CNS inflammatory activity. 118, 119 Regardless of the initial pathologic substrate, the inflammatory response present in relapsing-remitting multiple sclerosis plays a critical role in disease pathogenesis as evidenced by the success of numerous immune modulators, including interferon beta-1b 100 and beta-1a, 120, 121 glatiramer acetate, 122, 123 fingolimod, 81, 124 and teriflunomide 125 among many others, in reducing and in some instances eliminating neuroinflammation and clinical relapses.…”