Topical treatments for chronic plaque psoriasis

Objective measurement of erythema in psoriasis using digital color photography with color calibration

“…The most common form is plaque psoriasis, which presents with scaly red and white patches of the epidermal layer of the skin (1). These plaques often occur on the elbows and knees, but they can affect any part of the body.…”

Newer agents for psoriasis in adults

“…It found a significant improvement in disease severity (v placebo) with calcipotriol (17 studies; standardised mean difference (SMD) −0.96, 95% confidence interval −1.12 to −0.77), calcitriol (seven studies; −0.92, −1.54 to −0.29), and tacalcitol (four studies; −0.73, −1.09 to −0.37). 8 A European guidelines' systematic review of 19 studies (RCTs and observational studies) found that 25-58% of patients with mild to moderate chronic plaque psoriasis treated with vitamin D or its analogues showed a "significant improvement" or "near clearance" after twice daily application for six to eight weeks. 9 Absolute efficacy, measured using investigator's assessment of clear or nearly clear, gives a number needed to treat (NNT) of 7 (4 to 18; three moderate quality RCTs) for once daily calcipotriol, 2 (2 to 3; four moderate quality RCTs) for twice daily calcipotriol, 3 (1 to 7; two moderate quality RCTs) for twice daily calcitriol, and 8 (3 to 56; one low quality RCT) for once daily tacalcitol.…”

“…Not as effective in the short term as topical corticosteroids as monotherapy for chronic plaque psoriasis 1 Fewer adverse effects than corticosteroids 8 For psoriasis affecting the face, flexures, and genitalia ("sensitive areas") the National Institute for Health and Care Excellence recommends mild or moderately potent topical corticosteroids as first line treatment and topical calcineurin inhibitors as second line treatment. 1 It is recommended that topical calcineurin inhibitors are started by healthcare professionals with "expertise in treating psoriasis;" 1 among these drugs, topical tacrolimus has the most evidence.…”

Topical therapy for scalp psoriasis in adults: Table

“…An advantage of this product is that it can be used on the body as well as on the scalp. The authors of a Cochrane systematic review of evidence on topical treatments for chronic plaque psoriasis published in 2009 concluded that topical corticosteroids seem to be more effective than vitamin D products for treating scalp psoriasis 12. They also concluded that a combination of vitamin D plus corticosteroid is more effective than either component alone 12.…”

“…The authors of a Cochrane systematic review of evidence on topical treatments for chronic plaque psoriasis published in 2009 concluded that topical corticosteroids seem to be more effective than vitamin D products for treating scalp psoriasis 12. They also concluded that a combination of vitamin D plus corticosteroid is more effective than either component alone 12. There have been reports of calcipotriol scalp solutions causing an irritant effect, although in a large observational study involving 3,396 patients unwanted effects were only reported in 3% of patients after 8 weeks 13.…”