1
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Kotwiski FO, Albuquerque ECDMC, Lucchese AM. Topical foam as a promising carrier system for active pharmaceutical ingredients: review of clinical studies. Pharm Dev Technol 2023; 28:768-784. [PMID: 37632372 DOI: 10.1080/10837450.2023.2251556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 07/26/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
Skin disorders are preferentially treated by topical administration of medicines or cosmetics because of the possibility of local action. However, a great concern is the delivery of topical actives with effective penetration through the stratum corneum to ensure the desired effect. Considering the search for a carrier system that allows the penetration/permeation of active pharmaceutical ingredients through this structure, searching for effective topical pharmaceutical forms is needed. Foams have been widely studied over the years due to their high capacity to favor the active to overcome the cutaneous barrier and because this form of presentation has ease of application and high acceptability by users. The objective of this review was to analyze the potential of foam as a topical pharmaceutical form for treating skin disorders, upon clinical cases reported in the literature. Foam presents technical advantages when compared to other conventional topical pharmaceutical forms due to its fast action, high tolerance, and safety, with reduction or total remission of adverse events. Regarding the patient, foam increased the rate of adherence to the treatment. Therefore, it is concluded that foam is an effective, secure, and stable topical presentation form for carrying active pharmaceutical ingredients and widely accepted by patients.
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Affiliation(s)
- Fabiana O Kotwiski
- Biotechnology Graduate Program, State University of Feira de Santana, Feira de Santana, Bahia, Brazil
| | | | - Angélica M Lucchese
- Biotechnology Graduate Program, State University of Feira de Santana, Feira de Santana, Bahia, Brazil
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2
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Torres T, Galván J, Crutchley N, Praestegaard M, Iversen L, Gisondi P, Carrascosa JM, Halioua B, Bewley A, Pinter A. Calcipotriol and Betamethasone Dipropionate Cream Based on PAD Technology for the Treatment of Plaque Psoriasis: A Narrative Review. Dermatol Ther (Heidelb) 2023; 13:2153-2169. [PMID: 37740858 PMCID: PMC10539254 DOI: 10.1007/s13555-023-01003-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/02/2023] [Indexed: 09/25/2023] Open
Abstract
Topical treatment plays a crucial role in psoriasis management, with non-adherence being a major barrier to treatment success. The fixed-dose combination of calcipotriol (CAL) and betamethasone dipropionate (BDP) represents the first-line choice in topical psoriasis treatment. A CAL/BDP cream based on polyaphron dispersion (PAD) Technology has emerged as a novel formulation for a more convenient topical treatment of psoriasis. This article aims to summarize the most relevant published evidence about CAL/BDP PAD-cream and its underlying PAD Technology. The PAD Technology enables CAL and BDP stability in an aqueous cream through a multimolecular shell structure, as well as it increases the penetration of both active ingredients into the epidermis and dermis. This technology also demonstrated to increase the cosmetic acceptability and to provide the desirable sensory properties for a topical psoriasis treatment. Two phase III clinical trials have been conducted so far with CAL/BDP PAD-cream. Findings from both trials revealed high efficacy with a fast onset of action, a favourable safety and tolerability profile and convenience for CAL/BDP PAD-cream compared to CAL/BDP gel. In the trial including patients with psoriasis affecting the scalp (MC2-01-C7), results support the use of CAL/BDP PAD-cream in scalp psoriasis. An anchored matching-adjusted indirect comparison (MAIC) was conducted to compare CAL/BDP PAD-cream and CAL/BDP foam, as both products had been previously compared to CAL/BDP gel. CAL/BDP PAD-cream and CAL/BDP foam showed equivalent efficacy and quality of life at their recommended treatment duration, whereas greater treatment satisfaction for CAL/BDP PAD-cream was found after one week of treatment. Overall, the high patient acceptability and treatment satisfaction observed with CAL/BDP PAD-cream in clinical trials may lead to improved adherence and hence higher efficacy in clinical practice.
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Affiliation(s)
- Tiago Torres
- Department of Dermatology, Centro Hospitalar Universitário de Santo António, University of Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | | | | | | | - Lars Iversen
- MC2 Therapeutics, Hørsholm, Denmark
- Department of Dermatology and Venereology, Aarhus University Hospital, Aarhus, Denmark
| | - Paolo Gisondi
- Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - José Manuel Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, IGTP. UAB, Badalona, Spain
| | | | - Anthony Bewley
- Department of Dermatology, Barts Health NHS Trust & Queen Mary University, London, UK
| | - Andreas Pinter
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt Am Main, Frankfurt Am Main, Germany
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3
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Stein Gold L, Pinter A, Armstrong A, Augustin M, Arenberger P, Bhatia N, Praestegaard M, Iversen L, Reich A. Calcipotriene and Betamethasone Dipropionate PAD-Cream Demonstrates Greater Treatment Efficacy in Patients with Moderate-to-Severe Psoriasis Compared to Topical Suspension/Gel: A Subgroup Analysis of Two Phase 3 Studies. Dermatol Ther (Heidelb) 2023; 13:2031-2044. [PMID: 37490268 PMCID: PMC10442307 DOI: 10.1007/s13555-023-00979-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Psoriasis ranges from mild to severe with the majority of patients having mild disease. Mild to moderate disease is often treated with topical therapies while photo-, oral, and biologic therapies are generally reserved for moderate-to-severe disease. There is a strong scientific rationale for the combination of calcipotriene (CAL) and betamethasone dipropionate (BDP) with respect to mode of action, efficacy, and safety and CAL/BDP has shown an inhibitory effect on key pathogenic cytokines in psoriasis including tumor necrosis factor-α, interleukin (IL)-17, and IL-23. METHODS The objective of this pooled post hoc analysis is to investigate the efficacy of CAL/BDP polyaphron dispersion (PAD)-cream in subgroups of patients with moderate-to-severe psoriasis from two completed phase 3 studies conducted in the USA and Europe. RESULTS The proportion of patients achieving Physician Global Assessment (PGA) treatment success as well as a modified Psoriasis Area and Severity Index (mPASI)75 response was higher in the subgroup with a body surface area > 10% and mPASI > 10 and Dermatology Life Quality Index > 10 at baseline compared to the overall patient population. Furthermore, the numerical difference in treatment efficacy between CAL/BDP PAD-cream and CAL/BDP topical suspension/gel increased in patient subgroups with higher baseline severity. Similar patterns were shown for the patient-reported outcomes. CONCLUSION In this subgroup analysis, patients who had higher disease severity at baseline achieved greater efficacy than the total patient population when treated with 8 weeks of CAL/BDP PAD-cream as compared to a currently marketed active comparator. Additionally, as indicated by this analysis, CAL/BDP PAD-cream treatment may also be more convenient and less greasy, which may reduce the burden of daily treatment and improve adherence to therapy. TRIAL REGISTRATION NCT03308799 and NCT03802344.
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Affiliation(s)
- Linda Stein Gold
- Dermatology Clinical Research, Henry Ford Health System, Detroit, MI, USA
| | - Andreas Pinter
- Department of Dermatology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | | | | | - Petr Arenberger
- Department of Dermatology, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Neil Bhatia
- Therapeutics Clinical Research, San Diego, CA, USA
| | | | | | - Adam Reich
- Department of Dermatology, University of Rzeszow, Aleja Tadeusza Rejtana 16C, Rzeszow, Poland.
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4
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Tharmatt A, Sahel DK, Raza K, Pandey MM, Mittal A, Chitkara D. Topical delivery of Anti-VEGF nanomedicines for treating psoriasis. J Drug Deliv Sci Technol 2023. [DOI: 10.1016/j.jddst.2023.104365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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5
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Beladjine M, Albert C, Sintès M, Mekhloufi G, Gueutin C, Nicolas V, Canette A, Trichet M, Tsapis N, Michel L, Agnely F, Huang N. Pickering Emulsions Stabilized With Biodegradable Nanoparticles For The Co-Encapsulation Of Two Active Pharmaceutical Ingredients. Int J Pharm 2023; 637:122870. [PMID: 36948471 DOI: 10.1016/j.ijpharm.2023.122870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/24/2023]
Abstract
Innovative Pickering emulsions co-encapsulating two active pharmaceutical ingredients (API) were formulated for a topical use. An immunosuppressive agent, either cyclosporine A (CysA) or tacrolimus (TAC), was encapsulated at high drug loading in biodegradable and biocompatible poly (lactic-co-glycolic acid) (PLGA) nanoparticles (NP). These NP stabilized the oil droplets (Miglyol) containing an anti-inflammatory drug, calcitriol (CAL). The influence of the API on the physico-chemical properties of these emulsions were studied. Emulsions formulated with or without API had a similar macroscopic and microscopic structure, as well as interfacial properties, and they exhibited a good stability for at least 55 days. The emulsions did not alter the viability of human keratinocytes (HaCaT cell line) after 2 and 5 days of exposure to NP concentrations equivalent to efficient API dosages. Thus, these new Pickering emulsions appear as a promising multidrug delivery system for the treatment of chronical inflammatory skin diseases.
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Affiliation(s)
- Mohamed Beladjine
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, 91400, Orsay, France
| | - Claire Albert
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, 91400, Orsay, France
| | - Maxime Sintès
- Université Paris-Cité, Inserm, UMR-S 976 HIPI, Service de Dermatologie, Hôpital Saint Louis, 75010, Paris, France
| | - Ghozlene Mekhloufi
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, 91400, Orsay, France
| | - Claire Gueutin
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, 91400, Orsay, France
| | - Valérie Nicolas
- Université Paris-Saclay, SFR-UMS-IPSIT, Plateforme d'imagerie cellulaire MIPSIT, 91400, Orsay, France
| | - Alexis Canette
- Sorbonne Université, CNRS, Institut de Biologie Paris-Seine (IBPS), Service de microscopie électronique (IBPS-SME), F-75005, Paris
| | - Michaël Trichet
- Sorbonne Université, CNRS, Institut de Biologie Paris-Seine (IBPS), Service de microscopie électronique (IBPS-SME), F-75005, Paris
| | - Nicolas Tsapis
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, 91400, Orsay, France
| | - Laurence Michel
- Université Paris-Cité, Inserm, UMR-S 976 HIPI, Service de Dermatologie, Hôpital Saint Louis, 75010, Paris, France
| | - Florence Agnely
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, 91400, Orsay, France
| | - Nicolas Huang
- Université Paris-Saclay, CNRS, Institut Galien Paris-Saclay, 91400, Orsay, France.
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Jogdeo CM, Panja S, Kanvinde S, Kapoor E, Siddhanta K, Oupický D. Advances in Lipid-Based Codelivery Systems for Cancer and Inflammatory Diseases. Adv Healthc Mater 2023; 12:e2202400. [PMID: 36453542 PMCID: PMC10023350 DOI: 10.1002/adhm.202202400] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/13/2022] [Indexed: 12/03/2022]
Abstract
Combination therapy targeting multiple therapeutic targets is a favorable strategy to achieve better therapeutic outcomes in cancer and inflammatory diseases. Codelivery is a subfield of drug delivery that aims to achieve combined delivery of diverse therapeutic cargoes within the same delivery system, thereby ensuring delivery to the same site and providing an opportunity to tailor the release kinetics as desired. Among the wide range of materials being investigated in the design of codelivery systems, lipids have stood out on account of their low toxicity, biocompatibility, and ease of formulation scale-up. This review highlights the advances of the last decade in lipid-based codelivery systems focusing on the codelivery of drug-drug, drug-nucleic acid, nucleic acid-nucleic acid, and protein therapeutic-based combinations for targeted therapy in cancer and inflammatory diseases.
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Affiliation(s)
- Chinmay M. Jogdeo
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Sudipta Panja
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Shrey Kanvinde
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Ekta Kapoor
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Kasturi Siddhanta
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - David Oupický
- Center for Drug Delivery and Nanomedicine, Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE 68198, USA
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7
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Staubach P, Wurzer E, Hutt HJ, von Kiedrowski R. Prospective Observational Evaluation of Fixed Combination Calcipotriol/Betamethasone Aerosol Foam (Enstilar®) in the Management of Psoriasis with Scalp Involvement in Everyday Clinical Practice (the CAPITIS Study). Dermatology 2023; 239:206-216. [PMID: 36716728 PMCID: PMC10015748 DOI: 10.1159/000527496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/01/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND AIM Clinical trials have demonstrated the efficacy of fixed-dose combination calcipotriol/betamethasone (Cal/BD) aerosol foam for the treatment of patients with scalp psoriasis. However, data on the real-world effectiveness of Cal/BD aerosol foam in this subgroup of patients are lacking. Therefore, this study investigated the effectiveness and tolerability of 4 weeks' treatment with Cal/BD aerosol foam in patients with scalp psoriasis in everyday clinical practice. METHODS This prospective, non-interventional multicenter study involved 217 adults with scalp psoriasis who were treated with Cal/BD aerosol foam for 4 weeks. Primary endpoints included the proportion of patients with <10% of the scalp area affected (Scalp-BSA) plus a Scalp-PGA of "mild" after 4 weeks, as well as the proportion of patients with an absolute PSSI ≤2 points after 4 weeks. Secondary endpoints included patient reported changes in erythema, itching, flaking, and thickness at baseline, 3 days, 1 week, 2 weeks, and 4 weeks. RESULTS After 4 weeks, 53.4% of patients treated with Cal/BD aerosol foam had achieved a Scalp-BSA of <10% and a mild Scalp-PGA. Furthermore, 47.6% of patients achieved a PSSI ≤2. Improvements in pruritus and other symptoms (induration, erythema, and scaling) were seen already within 3 days. The proportion of patients who reported that scalp psoriasis had no influence on their quality of life (Dermatology Quality of Life Index 0/1 points) increased from 3.2% at baseline to 47.9% at study end. Patient satisfaction with treatment was high (Treatment Satisfaction Questionnaire-9 scores of 74.5 ± 27.1 for effectiveness, 72.0 ± 25.2 for ease of use, and 77.8 ± 24.2 for general satisfaction). Overall, 97.4% of HCPs assessed the tolerability of Cal/BD aerosol foam as good/very good with no new safety concerns. CONCLUSION This study demonstrated the effectiveness, rapid onset of action, good tolerability, and good safety profile of the Cal/BD aerosol foam in patients with scalp psoriasis treated in a real-world setting.
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Affiliation(s)
- Petra Staubach
- Department of Dermatology and Allergy, University Medical Center, Mainz, Germany
| | | | | | - Ralph von Kiedrowski
- Dermatologische Spezialpraxis für chronisch-entzündliche System-Dermatosen, Dermato-Onkologie und Allergologie, Selters (Westerwald), Germany
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8
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De Simone C, Dapavo P, Malagoli P, Martella A, Campanati A, Campione E, Errichetti E, Franchi C, Gambardella A, Megna M, Osti F, Ribero S, Zagni G, Calzavara‐Pinton P, Fabbrocini G, Amoruso GF, Baglieri F, Biamonte AS, Bianchelli T, Bigi L, Bortoli J, Brunetti B, Buligan C, Cagni E, Calderoni O, Calzavara‐Pinton P, Campanati A, Caputo A, Carrera CG, Carugno A, Chersi K, Cicchelli S, De Natale F, De Simone C, Dapavo P, Di Maria D, Errichetti E, Fabbrocini G, Ferrari AS, Fogli E, Forconi R, Franchi C, Galeazzi A, Gambardella A, Giovannini A, Giura MT, Iuculano M, Lazzaretti G, Leporati C, Magnanini M, Malagoli P, Marconi B, Martella A, Maruccia A, Megna M, Miglietta R, Minuti A, Mocci L, Modica S, Narcisi A, Odorici G, Osti F, Pazzaglia M, Peila R, Pertusi G, Pezza M, Pezzullo E, Puccia N, Raulo U, Ribero S, Rossi M, Rusignuolo S, Sapienza G, Savarese C, Scalisi M, Strippoli D, Stroppiana E, Tiberio R, Trischitta A, Tucci MG, Vaira F, Verrone A, Villa L, Zagni F, Zoccali A. Long-term proactive management of psoriasis with calcipotriol and betamethasone dipropionate foam: an Italian consensus through a combined nominal group technique and Delphi approach. Int J Dermatol 2022; 61:1543-1551. [PMID: 35609147 PMCID: PMC9790732 DOI: 10.1111/ijd.16192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/20/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although long-term management of psoriasis is paramount, this approach is challenging in clinical practice. In the recent PSO-LONG trial, a fixed-dose combination of betamethasone dipropionate (BD) and calcipotriol (Cal) foam applied twice a week on non-consecutive days for 52 weeks (proactive treatment) reduced the risk of relapse. However, the role of Cal/BD foam in the long-term management of psoriasis needs further clarifications. The ProActive Management (PAM) program, a nationwide Italian project, aims at reaching a consensus on the role of proactive management of psoriasis. METHODS A steering committee generated some statements through the nominal group technique (NGT). The statements were voted by an expert panel in an adapted Delphi voting process. RESULTS Eighteen statements were proposed, and the majority of them (14/18) reached a consensus during the Delphi voting. The need to provide long-term proactive topical treatment to reduce the risk of relapse for the treatment of challenging diseases sites or in patients where phototherapy or systemic therapies are contraindicated/ineffective was widely recognized. A consensus was reached about the possibility to associate the proactive treatment with systemic and biological therapies, without the need for dose intensification, thus favoring a prolonged remission. Moreover, the proactive treatment was recognized as more effective than weekend therapy in increasing time free from relapses. Approaches to improve adherence, on the other hand, need further investigation. CONCLUSIONS The inclusion in guidelines of a proactive strategy among the effective treatment options will be a fundamental step in the evolution of a mild-moderate psoriasis therapeutic approach.
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Affiliation(s)
- Clara De Simone
- Department of DermatologyCatholic University of the Sacred Heart, Policlinico ‘A. Gemelli’, IRCCSRomeItaly
| | - Paolo Dapavo
- ASO City of Health and ScienceUniversity Dermatological ClinicTorinoItaly
| | | | | | - Anna Campanati
- Dermatology Unit, Department of Clinical and Molecular SciencesPolytechnic Marche UniversityAnconaItaly
| | - Elena Campione
- Dermatologic Unit, Department of Systems MedicineUniversity of Rome Tor VergataRomeItaly
| | - Enzo Errichetti
- Institute of DermatologyS.Maria della Misericordia University HospitalUdineItaly
| | | | - Alessio Gambardella
- Department of Precision Medicine, Dermatology UnitUniversità degli Studi della Campania L. VanvitelliNaplesItaly
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINaplesItaly
| | | | - Simone Ribero
- Medical Sciences Department, Section of DermatologyUniversity of TurinTurinItaly
| | | | | | - Gabriella Fabbrocini
- Institute of DermatologyS.Maria della Misericordia University HospitalUdineItaly
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9
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Antimicrobial and Anti-Inflammatory Activity of Low-Energy Assisted Nanohydrogel of Azadirachta indica Oil. Gels 2022; 8:gels8070434. [PMID: 35877519 PMCID: PMC9318572 DOI: 10.3390/gels8070434] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 02/04/2023] Open
Abstract
Plant-based bioactive compounds have been utilized to cure diseases caused by pathogenic microorganisms and as a substitute to reduce the side effects of chemically synthesized drugs. Therefore, in the present study, Azadirachta indica oil nanohydrogel was prepared to be utilized as an alternate source of the antimicrobial compound. The total phenolic compound in Azadirachta indica oil was quantified by chromatography analysis and revealed gallic acid (0.0076 ppm), caffeic acid (0.077 ppm), and syringic acid (0.0129 ppm). Gas chromatography−mass spectrometry analysis of Azadirachta indica oil revealed the presence of bioactive components, namely hexadecenoic acid, heptadecanoic acid, ç-linolenic acid, 9-octadecanoic acid (Z)-methyl ester, methyl-8-methyl-nonanoate, eicosanoic acid, methyl ester, and 8-octadecane3-ethyl-5-(2 ethylbutyl). The nanohydrogel showed droplet size of 104.1 nm and −19.3 mV zeta potential. The nanohydrogel showed potential antimicrobial activity against S. aureus, E. coli, and C. albicans with minimum inhibitory, bactericidal, and fungicidal concentrations ranging from 6.25 to 3.125 (µg/mL). The nanohydrogel showed a significantly (p < 0.05) higher (8.40 log CFU/mL) value for Gram-negative bacteria E. coli compared to Gram-positive S. aureus (8.34 log CFU/mL), and in the case of pathogenic fungal strain C. albicans, there was a significant (p < 0.05) reduction in log CFU/mL value (7.79−6.94). The nanohydrogel showed 50.23−82.57% inhibition in comparison to standard diclofenac sodium (59.47−92.32%). In conclusion, Azadirachta indica oil nanohydrogel possesses great potential for antimicrobial and anti-inflammatory activities and therefore can be used as an effective agent.
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10
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Jalili A, Bewley A, Sticherling M, Stein Gold L. Short Term and Long-Term Efficacy of Calcipotriene/ Betamethasone Dipropionate Foam Combination. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:809-814. [PMID: 35531463 PMCID: PMC9075015 DOI: 10.2147/ccid.s361884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/15/2022] [Indexed: 11/23/2022]
Abstract
Psoriasis is a well-known chronic disease characterized by the development of erythematous, indurated, scaly, pruritic plaques on the skin with cycles of remission and symptom flare-ups. The management of patients with chronic plaque psoriasis has been more challenging since the Covid-19 pandemic as health care professionals have had to adapt to remote consultations for some patients, and patients have had to adapt to the changing health landscape. The rapid resolution of psoriasis symptoms especially those with a substantial impact on quality of life can improve patient satisfaction and adherence, making it an important factor in successful treatment. Cal/BD foam contributes to improved patient adherence and treatment outcome through its rapid action and superior efficacy versus Cal or BD monotherapy, Cal/BD ointment and gel and clobetasol cream in the short-term flare treatment of psoriasis. Moreover, the benefits of proactive long-term management of psoriasis compared to reactive management and its favourable safety profile are higher efficacy and a better health-related quality of life. Cal/BD foam should be considered an effective topical treatment for short-term flare treatment and long-term control of adult psoriatic patients.
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Affiliation(s)
- Ahmad Jalili
- Dermatology & Skin Care Clinic, Buochs, Switzerland
| | - Anthony Bewley
- Barts Health NHS Trust and Queen Mary University London, London, UK
| | - Michael Sticherling
- Department of Dermatology, Psoriasis Center, University Medical Center, Erlangen, Germany
| | - Linda Stein Gold
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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Fabbrocini G, De Simone C, Dapavo P, Malagoli P, Martella A, Calzavara Pinton P. Long-term maintenance treatment of psoriasis: the role of calcipotriol/betamethasone dipropionate aerosol foam in clinical practice. J DERMATOL TREAT 2021; 33:2425-2432. [PMID: 34694953 DOI: 10.1080/09546634.2021.1998310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Most patients with psoriasis present with localized mild-to-moderate disease. In this case, the application of topical treatments in the first-line setting is recommended in most cases.Among different topical options, the fixed-dose combination of betamethasone dipropionate (BD) and vitamin D analogue (Cal) aerosol foam (Enstilar®, Leo Pharma) is approved as first-line topical therapy for the treatment of psoriasis in USA and the EU, due to its high efficacy and its favorable administration scheme.The PSO-LONG was the first trial to report on the long-term efficacy and safety of the Cal/DB foam treatment for the proactive management of psoriasis and now, the indications of Cal/BD foam included its use in the psoriasis maintenance treatment. However, the precise role of this treatment and the potential therapeutic schemes in the long-term management of psoriasis need further clarification.This Position Paper, authored by a group of Italian Expert Dermatologists, critically discusses the long-term management of psoriasis with Cal/BD foam in clinical practice. In particular, the biological rationale in the proactive treatment with Cal/BD foam and current evidence regarding this therapeutic approach are presented, along with its application also in patients with moderate-to-severe disease, difficult-to-treat lesions, or within combination regimens. In addition, strategies to improve adherence to long-term treatment of psoriasis are discussed.
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Affiliation(s)
- G Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - C De Simone
- Department of Dermatology, Catholic University of the Sacred Heart, Policlinico "A. Gemelli", IRCCS, Rome, Italy
| | - P Dapavo
- ASO City of Health and Science, University Dermatological Clinic, Corso Vittorio Emanuele II, 62, Torino, Italy
| | - P Malagoli
- Head Psocare Unit, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, San Donato, Milano, Italy
| | - A Martella
- Myskin Dermatology Practice, Tiggiano, Lecce, Italy
| | - P Calzavara Pinton
- Dermatology Department, University of Brescia, ASST Spedali Civili, P.le Spedali Civili, 1, Brescia, Italy
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12
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Tada Y, Iversen L, Koo J. Early efficacy and safety data with fixed-dose combination calcipotriol/betamethasone dipropionate foam attributed to mechanism of absorption and steroid potency. J Eur Acad Dermatol Venereol 2021; 35 Suppl 1:5-9. [PMID: 33619779 PMCID: PMC7986689 DOI: 10.1111/jdv.17027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/27/2020] [Indexed: 01/16/2023]
Abstract
Topical therapy is the mainstay of treatment for the majority of patients with psoriasis vulgaris (chronic plaque psoriasis), with combinations of vitamin D analogues and glucocorticoids having been shown to negate many of the negative effects associated with either monocomponent individually. Following the established efficacy of fixed‐dose combination calcipotriol (Cal; 50 µg/g) plus betamethasone dipropionate (BD; 0.5 mg/g) ointment and gel formulations, a novel Cal/BD foam formulation was developed. When applied, Cal/BD foam forms a supersaturated solution on the skin, increasing the penetration and bioavailability of Cal and BD. Early data indicate that this results in improved efficacy outcomes versus Cal/BD ointment, without negatively affecting safety outcomes (such as the incidence/severity of side effects or impacted calcium homeostasis or hypothalamic‐pituitary‐adrenal axis). This article discusses the potency and absorption of fixed‐dose combination Cal/BD foam, as well as the positive early efficacy and safety data associated with its utilisation in the treatment of psoriasis vulgaris. Video abstract
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Affiliation(s)
- Y Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - L Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - J Koo
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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13
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Herrmann N, Nümm TJ, Iwamoto K, Leib N, Koch S, Majlesain Y, Maintz L, Kirins H, Schnautz S, Bieber T. Vitamin D 3-Induced Promotor Dissociation of PU.1 and YY1 Results in FcεRI Reduction on Dendritic Cells in Atopic Dermatitis. THE JOURNAL OF IMMUNOLOGY 2021; 206:531-539. [PMID: 33443066 DOI: 10.4049/jimmunol.2000667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022]
Abstract
Atopic dermatitis (AD) is a severe inflammatory skin disease. Langerhans cells and inflammatory dendritic epidermal cells (IDEC) are located in the epidermis of AD patients and contribute to the inflammatory processes. Both express robustly the high-affinity receptor for IgE, FcεRI, and thereby sense allergens. A beneficial role of vitamin D3 in AD is discussed to be important especially in patients with allergic sensitization. We hypothesized that vitamin D3 impacts FcεRI expression and addressed this in human ex vivo skin, in vitro Langerhans cells, and IDEC models generated from primary human precursor cells. We show in this article that biologically active vitamin D3 [1,25(OH)2-D3] significantly downregulated FcεRI at the protein and mRNA levels of the receptor's α-chain, analyzed by flow cytometry and quantitative RT-PCR. We also describe the expression of a functional vitamin D receptor in IDEC. 1,25(OH)2-D3-mediated FcεRI reduction was direct and resulted in impaired activation of IDEC upon FcεRI engagement as monitored by CD83 expression. FcεRI regulation by 1,25(OH)2-D3 was independent of maturation and expression levels of microRNA-155 and PU.1 (as upstream regulatory axis of FcεRI) and transcription factors Elf-1 and YY1. However, 1,25(OH)2-D3 induced dissociation of PU.1 and YY1 from the FCER1A promotor, evaluated by chromatin immunoprecipitation. We show that vitamin D3 directly reduces FcεRI expression on dendritic cells by inhibiting transcription factor binding to its promotor and subsequently impairs IgE-mediated signaling. Thus, vitamin D3 as an individualized therapeutic supplement for those AD patients with allergic sensitization interferes with IgE-mediated inflammatory processes in AD patients.
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Affiliation(s)
- Nadine Herrmann
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and .,Christine Kühne-Center for Allergy Research and Education, CH-7265 Davos, Switzerland
| | - Tim J Nümm
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and.,Christine Kühne-Center for Allergy Research and Education, CH-7265 Davos, Switzerland
| | - Kazumasa Iwamoto
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and
| | - Nicole Leib
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and.,Christine Kühne-Center for Allergy Research and Education, CH-7265 Davos, Switzerland
| | - Susanne Koch
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and
| | - Yasmin Majlesain
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and
| | - Laura Maintz
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and.,Christine Kühne-Center for Allergy Research and Education, CH-7265 Davos, Switzerland
| | - Helene Kirins
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and
| | - Sylvia Schnautz
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital of Bonn, D-53127 Bonn, Germany; and.,Christine Kühne-Center for Allergy Research and Education, CH-7265 Davos, Switzerland
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14
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General practice recommendations for the topical treatment of psoriasis: a modified-Delphi approach. BJGP Open 2020; 4:bjgpopen20X101108. [PMID: 33144365 PMCID: PMC7880171 DOI: 10.3399/bjgpopen20x101108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/19/2020] [Indexed: 11/13/2022] Open
Abstract
Background Although GPs are usually the first port of call for patients with psoriasis, there is a lack of consistent and up-to-date clinical recommendations for interventions for patients with mild-to-moderate disease. Aim To provide practical recommendations for GPs to optimise psoriasis treatment with topical therapies in four key areas: patient identification; treatment decision making with topical theory; topical treatment outcomes; and optimising patient adherence. Design & setting A consensus-seeking programme (modified-Delphi approach) was undertaken to assess the literature and develop recommendations for GPs, based on evidence and expert opinion. Method Three dermatologists compiled 47 questions that were subsequently ranked and refined according to clinical relevance or importance using an online survey. Thereafter, 19 dermatologists from different European countries developed statements and clinical recommendations for the top seven ranked topical treatment and GP-relevant questions based on literature research and clinical experience. The final recommendations were based on 100% agreement among a final panel of seven experts. Results The clinical effectiveness, fast onset of action, tolerability, cosmetic acceptability, and practicability of topical therapy, in addition to good physician—patient communication, are important for optimising patient adherence and maximising efficacy. Topical treatments combining corticosteroids and vitamin D analogues (administered as fixed combination) are well-established first-line treatments in mild-to-moderate psoriasis. Conclusion Simple but detailed practical guidance is provided, which is formed from evidence and expert clinical recommendations, to assist GPs with the optimal use of topical agents based on efficacy, tolerability, disease severity, site of psoriasis, patient lifestyle and preferences, and intended duration of treatment.
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Inflammation, HIV, and Immune Quiescence: Leveraging on Immunomodulatory Products to Reduce HIV Susceptibility. AIDS Res Treat 2020; 2020:8672850. [PMID: 33178456 PMCID: PMC7609152 DOI: 10.1155/2020/8672850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/23/2020] [Accepted: 10/15/2020] [Indexed: 12/29/2022] Open
Abstract
The relationship between inflammation and HIV has been a focus of research over the last decade. In HIV-infected individuals, increased HIV-associated immune activation significantly correlated to disease progression. While genital inflammation (GI) has been shown to significantly increase the risk of HIV acquisition and transmission, immune correlates for reduced risk remain limited. In certain HIV-exposed seronegative individuals, an immune quiescent phenotype characterized reduced risk. Immune quiescence is defined by specific, targeted, highly regulated immune responses that hinder overt inflammation or immune activation. Targeted management of inflammation, therefore, is a plausible strategy to mitigate HIV risk and slow disease progression. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as hydroxychloroquine and aspirin have shown encouraging preliminary results in low-risk women by reducing systemic and genital immune activation. A topical NSAID, containing ibuprofen, is effective in treating vulvovaginal inflammation. Additionally, the glucocorticoids (GCs), prednisolone, and dexamethasone are used to treat HIV-associated immune activation. Collectively, these data inform on immune-modulating drugs to reduce HIV risk. However, the prolonged use of these pharmaceutical drugs is associated with adverse effects, both systemically and to a lesser extent topically. Natural products with their reduced side effects coupled with anti-inflammatory properties render them viable options. Lactic acid (LA) has immunomodulatory properties. LA regulates the genital microbiome by facilitating the growth of Lactobacillus species, while simultaneously limiting bacterial species that cause microbial dysbiosis and GI. Glycerol monolaurate, besides being anti-inflammatory, also inhibited SIV infections in rhesus macaques. The proposed pharmaceutical and natural products could be used in combination with either antiretrovirals for treatment or preexposure prophylaxis for HIV prevention. This review provides a summary on the associations between inflammation, HIV risk, and disease progression. Furthermore, we use the knowledge from immune quiescence to exploit the use of pharmaceutical and natural products as strategic interventions to manage inflammation, toward mitigating HIV infections.
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Segaert S, Calzavara-Pinton P, de la Cueva P, Jalili A, Lons Danic D, Pink AE, Thaçi D, Gooderham M. Long-term topical management of psoriasis: the road ahead. J DERMATOL TREAT 2020; 33:111-120. [DOI: 10.1080/09546634.2020.1729335] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | - Pablo de la Cueva
- Department of Dermatology, University Hospital Infanta Leonor de Madrid, Madrid, Spain
| | - Ahmad Jalili
- Department of Dermatology, Bürgenstock Medical Center, Obbürgen, Switzerland
| | | | - Andrew E. Pink
- St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Melinda Gooderham
- SKiN Centre for Dermatology, Probity Medical Research and Queen’s University, Peterborough, Canada
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17
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Patient and Physician Satisfaction with Calcipotriol and Betamethasone Dipropionate Aerosol Foam in the Treatment of Plaque Psoriasis on the Body. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
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18
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Lin X, Meng X, Song Z. Vitamin D and alopecia areata: possible roles in pathogenesis and potential implications for therapy. Am J Transl Res 2019; 11:5285-5300. [PMID: 31632510 PMCID: PMC6789271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Abstract
Alopecia areata is characterized by the loss of hair on the scalp and elsewhere on the body. It affects approximately 2% of the general population. It is believed to be an autoimmune disease. However, its pathogenesis remains incompletely understood. Recent studies have revealed a substantial link between vitamin D and alopecia areata. But the underlying mechanism still yet to be deciphered. This article reviews the current literature and discusses the possible roles of vitamin D in the pathogenesis of alopecia areata in the context of (1) loss of immune privilege in hair follicle, (2) autoreactive effector T cells and mast cells, (3) nature killer group 2 member d-positive cytotoxic T cells, (4) Janus kinase/signal transducers and activators of transcriptional signaling pathway, (5) regulatory T cells, (6) immune checkpoints, and (7) oxidative stress, which are believed to play important roles in autoimmunity in AA. This paper provides new insights into research directions to elucidate the exact mechanisms of vitamin D in the pathogenesis. Calcipotriol, a vitamin D analog, has been reported to be topically used in treating alopecia areata with promising results. Combination therapy of vitamin D analogs with corticosteroids might also be used in treating alopecia areata.
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Affiliation(s)
- Xiran Lin
- Department of Dermatology, The First Affiliated Hospital of Dalian Medical University222 Zhongshan Road, Dalian 116011, China
| | - Xianmin Meng
- Department of Pathology and Laboratory Medicine, Axia Women’s Health450 Cresson BLVD. Oaks, PA 19456, USA
| | - Zhiqi Song
- Department of Dermatology, The First Affiliated Hospital of Dalian Medical University222 Zhongshan Road, Dalian 116011, China
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19
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Velasco M, González-Fernández D, Rodriguez-Martín M, Sánchez-Regaña M, Pérez-Barrio S. Patient and Physician Satisfaction with Calcipotriol and Betamethasone Dipropionate Aerosol Foam in the Treatment of Plaque Psoriasis on the Body. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:752-758. [PMID: 31256797 DOI: 10.1016/j.ad.2019.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/06/2019] [Accepted: 03/10/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Calcipotriol and betamethasone dipropionate (Cal/BD) aerosol foam is more effective in the treatment of plaque psoriasis than earlier formulations incorporating this combination of active ingredients. The aim of this study was to evaluate patient and physician satisfaction with Cal/BD aerosol foam in the treatment of plaque psoriasis on the body. MATERIAL AND METHODS Retrospective observational study of 446 patients with plaque psoriasis affecting no more than 30% of the body surface area who had received treatment with Cal/BD aerosol foam for 4 weeks. The patients rated their satisfaction with the treatment using the TSQM-9 (Treatment Satisfaction Questionnaire for Medication) and the physicians on a 5-point Likert scale. RESULTS Patients were highly satisfied with Cal/BD aerosol in terms of its ability to treat their condition (84%), relieve their symptoms (84.4%), and act rapidly (82.8%). With respect to convenience, the patients gave high ratings to ease of use (91.8%), ease of planning (93.9%), and ease of following instructions (89.9%). Global satisfaction was also high, with 85% of patients expressing that they were satisfied, very satisfied, or extremely satisfied with the treatment. Of the physicians, 85.7% stated that they were quite or very satisfied with the treatment. CONCLUSION Both patients and physicians expressed high satisfaction with the use of Cal/BD aerosol foam for the treatment of plaque psoriasis on the body.
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Affiliation(s)
- M Velasco
- Servicio de Dermatología, Hospital Arnau de Vilanova, Valencia, España.
| | - D González-Fernández
- Servicio de Dermatología, Hospital Universitario Cabueñes, Gijón, Asturias, España
| | - M Rodriguez-Martín
- Servicio de Dermatología, Dermaten Clínicas, Santa Cruz de Tenerife, España
| | - M Sánchez-Regaña
- Servicio de Dermatología, Clínica Dermacot, Mataró, Barcelona, España
| | - S Pérez-Barrio
- Servicio de Dermatología, Hospital Universitario Basurto, Bilbao, España
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20
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Petrunin DD. Pharmacotherapy: Its impact on morphofunctional characteristics of the epidermal barrier. VESTNIK DERMATOLOGII I VENEROLOGII 2019. [DOI: 10.25208/0042-4609-2019-95-1-59-76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Various pharmaceuticals used for topical and systemic therapy are capable of exerting significant impact on morphological and physiological characteristics of human epidermis, as well as its barrier properties. This may affect the course of dermatologic diseases and the efficacy of their treatment. In this literature review, the author analyzes the impact of various pharmaceutical classes on the morphofunctional characteristics of the epidermal barrier and formulates recommendations for skin disease treatment.
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21
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Puig L, Carretero G. Update on Topical Treatments for Psoriasis: The Role of Calcipotriol Plus Betamethasone Dipropionate Aerosol Foam. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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22
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Sakaguchi C, Ashida K, Yano S, Ohe K, Wada N, Hasuzawa N, Matsuda Y, Sakamoto S, Sakamoto R, Uchi H, Furue M, Nomura M, Ogawa Y. A case of nivolumab-induced acute-onset type 1 diabetes mellitus in melanoma. ACTA ACUST UNITED AC 2019; 26:e115-e118. [PMID: 30853818 DOI: 10.3747/co.26.4130] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nivolumab, an anti-PD-1 antibody, is now considered an important therapeutic agent in several advanced malignancies. However, immune-related adverse events such as endocrinopathies have been reported with its use. Thyroid disorder and isolated adrenocorticotropic hormone deficiency have frequently been reported as nivolumab-induced immune-related adverse events. Another endocrinopathy is nivolumab-induced type 1 diabetes mellitus (t1dm), described as diabetes mellitus with rapid onset and complete insulin insufficiency, at times leading to fulminant t1dm. We report the case of a 68-year-old woman who developed pancreatic islet-related autoantibody-negative t1dm, possibly induced by nivolumab, under continuous glucocorticoid administration. She was treated with nivolumab for advanced malignant melanoma, concomitant with 10 mg prednisolone daily for thrombophlebitis tapered to 5 mg after 13 courses of nivolumab therapy. At approximately the 27th course of nivolumab therapy, she showed elevated plasma glucose levels despite preserved insulin secretion. A month later, she developed diabetic ketoacidosis. Her insulin secretion decreased and finally was exhausted. She was diagnosed with acute-onset rather than fulminant t1dm because of a rapidly progressive course to diabetic ketoacidosis during just more than 1 week. She is currently receiving insulin replacement. There has been no recurrence of the melanoma. Thus, nivolumab might induce autoimmune diabetes mellitus, with patients having t1dm-sensitive human leucocyte antigen being more susceptible even when receiving glucocorticoids. Physicians should be aware that nivolumab could potentially induce t1dm as a critical immune-related adverse event.
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Affiliation(s)
- C Sakaguchi
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan
| | - K Ashida
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - S Yano
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan
| | - K Ohe
- Faculty of Pharmaceutical Sciences, Fukuoka University, Japan
| | - N Wada
- Department of Dermatology, Kyushu University Hospital, Fukuoka City, Japan
| | - N Hasuzawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Y Matsuda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan
| | - S Sakamoto
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan
| | - R Sakamoto
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan
| | - H Uchi
- Department of Dermatology, Kyushu University Hospital, Fukuoka City, Japan
| | - M Furue
- Department of Dermatology, Kyushu University Hospital, Fukuoka City, Japan
| | - M Nomura
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Y Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Japan
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Xia L, Li R, Wang Y, Lin Z, Zheng J, Li X, Lu Q, Zhang J, Jin H, Fu L, Zhang X, Liu Y, Yang S, Xiao F, Gao XH. Efficacy, safety, and cost-effectiveness of all-trans retinoic acid/Clobetasol Propionate Compound Ointment in the treatment of mild to moderate psoriasis vulgaris: A randomized, single-blind, multicenter clinical trial. Dermatol Ther 2018; 31:e12632. [PMID: 30253049 DOI: 10.1111/dth.12632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/25/2018] [Accepted: 06/01/2018] [Indexed: 11/27/2022]
Abstract
To assess the efficacy, safety, and cost-effectiveness of all-trans retinoic acid/Clobetasol Propionate Compound Ointment and calcipotriol/betamethasone dipropionate ointment in the treatment of mild-to-moderate patients with psoriasis vulgaris. This was a randomized, single-blind, multicenter clinical trial. A total of 240 patients were randomized to receive twice-daily all-trans retinoic acid/Clobetasol Propionate Compound Ointment (treatment group) or once-daily calcipotriol/betamethasone dipropionate ointment (control group) for 4 weeks. The efficacy, safety, and cost-effectiveness were assessed at Weeks 2 and 4. After 4 weeks, both groups showed a significant clinical improvement compared to baseline (88.33% vs. 89.83%, respectively, p = .7112). But PASI 75 response in the treatment group was superior to the control group (44.12% vs. 28.57%, respectively, p = .0200), at Week 4. SSRI improvement rate in the treatment group was also superior to control group (67.11% vs. 59.43%, respectively, p = .0119) at Week 4. All-trans retinoic acid/Clobetasol Propionate Compound Ointment showed a significant clinical improvement in erythema, infiltration, and scales of skin lesions and PASI score compared to baseline. 1.67% of patients (treatment group) reported adverse reactions compared to 2.50% (control group) with no statistical significance. In addition, the cost-effectiveness assessment showed a higher cost-effectiveness of the treatment group compared to the control group in 4 weeks (199.25 vs. 801.51). All-trans retinoic acid/Clobetasol Propionate Compound Ointment was effective and safe in the treatment of psoriasis vulgaris with similar efficacy as calcipotriol/betamethasone dipropionate ointment and lower treatment costs.
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Affiliation(s)
- Lixin Xia
- Department of Dermatology of The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ruoyu Li
- Department of Dermatology of Peking University First Hospital, Beijing, China
| | - Yun Wang
- Department of Dermatology of Peking University First Hospital, Beijing, China
| | - Zhimiao Lin
- Department of Dermatology of Peking University First Hospital, Beijing, China
| | - Jie Zheng
- Department of Dermatology of RuiJin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xia Li
- Department of Dermatology of RuiJin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qianjin Lu
- Department of Dermatology of The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jing Zhang
- Department of Dermatology of The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Hongzhong Jin
- Department of Dermatology of Peking Union Medical College Hospital, Beijing, China
| | - Lanqin Fu
- Department of Dermatology of Peking Union Medical College Hospital, Beijing, China
| | - Xibao Zhang
- Department of Dermatology of Guangzhou Institute of Dermatology, Guangzhou, Guangdong, China
| | - Yumei Liu
- Department of Dermatology of Guangzhou Institute of Dermatology, Guangzhou, Guangdong, China
| | - Sen Yang
- Department of Dermatology of The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui
| | - Fengli Xiao
- Department of Dermatology of The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui
| | - Xing-Hua Gao
- Department of Dermatology of The First Hospital of China Medical University, Shenyang, Liaoning, China
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24
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Puig L, Carretero G. Update on Topical Treatments for Psoriasis: The Role of Calcipotriol Plus Betamethasone Dipropionate Aerosol Foam. ACTAS DERMO-SIFILIOGRAFICAS 2018; 110:115-123. [PMID: 30031488 DOI: 10.1016/j.ad.2018.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/11/2018] [Accepted: 05/28/2018] [Indexed: 01/05/2023] Open
Abstract
Topical agents are the first-line treatment for mild and moderate psoriasis, but factors such as frequency of administration, organoleptic properties, and the limited short term results can reduce treatment adherence and effectiveness. Innovations in topical treatments are linked not only to the discovery of new molecules, but also to the reformulation of existing active ingredients based on improvements to administration, organoleptic properties, bioavailability, and ease of use. Calcipotriol and betamethasone dipropionate aerosol foam is a new formulation in which the active ingredients are dissolved in a mixture of volatile propellants that evaporate quickly, leaving a supersaturated solution of calcipotriol and betamethasone dipropionate that enhances penetration into the epidermis. In this article, we take a look at the new calcipotriol and betamethasone dipropionate aerosol formulation and briefly review the main evidence supporting the use of topical treatments for psoriasis.
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Affiliation(s)
- L Puig
- Departamento de Dermatología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España.
| | - G Carretero
- Departamento de Dermatología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España
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25
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Imafuku S, Zheng M, Tada Y, Zhang X, Theng C, Thevarajah S, Zhao Y, Song HJ. Asian consensus on assessment and management of mild to moderate plaque psoriasis with topical therapy. J Dermatol 2018; 45:805-811. [PMID: 29740870 PMCID: PMC6055873 DOI: 10.1111/1346-8138.14338] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/27/2018] [Indexed: 11/30/2022]
Abstract
A working group of dermatologists in Asian countries assessed the current status of psoriatic management in the region to prepare a consensus report on topical treatment in mild to moderate plaque psoriasis. Even though the association of psoriasis with systemic comorbidities is increasingly acknowledged, psoriasis is still lower in health‐care priority lists in the region. The psychosocial impact of psoriasis may be greater in Asian countries due to cultural norms and social discrimination. Non‐adherence to treatment is also common among Asians. The current care given to patients with mild to moderate psoriasis needs to be streamlined, enhanced and organized with a patient‐centered care approach to achieve better outcomes. A comprehensive assessment of the disease severity and its impact on a patient's life is required before initiating treatment. Education and active involvement of the patient in the treatment plan is an important part of psoriatic management. It is recommended to personalize topical treatment to meet the needs of the patient, depending on disease severity, psychosocial impact, the patient's expectations and, more importantly, the patient's willingness and ability to actively follow the treatment procedure. Fixed‐dose combination of corticosteroid and vitamin D analogs is the preferred topical medication for both initial and maintenance phases of treatment. The fast containment of the disease is the goal of the initial phase of 4–8 weeks and it demands a potent fast‐acting topical therapy. Satisfactory control of the disease and prevention of relapses should be achieved during the maintenance phase with twice a week or weekend applications.
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Affiliation(s)
- Shinichi Imafuku
- Department of Dermatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Min Zheng
- Department of Dermatology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yayoi Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Xibao Zhang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, China
| | - Colin Theng
- The Skin Specialists & Laser Clinic, Singapore
| | | | - Yi Zhao
- Department of Dermatology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Hae Jun Song
- Department of Dermatology, Guro Hospital, College of Medicine, Korea University, Seoul, Korea
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26
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Yan L, Gu Y, Luan T, Miao M, Jiang L, Liu Y, Li P, Zeng X. Associations between serum vitamin D and the risk of female reproductive tumors: A meta-analysis with trial sequential analysis. Medicine (Baltimore) 2018; 97:e0360. [PMID: 29642181 PMCID: PMC5908580 DOI: 10.1097/md.0000000000010360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 02/06/2018] [Accepted: 03/15/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Female reproductive tumors are common with high morbidity and mortality worldwide; however, the association between gynecological tumors and serum vitamin D is controversial. The aim of this meta-analysis was to evaluate the relationship between insufficiency of serum vitamin D and the occurrence of benign and malignant gynecological tumors. METHODS Studies from inception to June 2017 were searched in the electronic databases: National Library of Medicine (PubMed), Web of Science (Clerivate), and Cochrane Database of Systematic Reviews (Cochrane Library, CDSR) by 2 investigators independently. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. STATA 12.0 Software and Trial Sequential Analysis (TSA) software were applied for data analyses. RESULTS Overall, 8 studies (including 2391 patients and 5798 patients with and without female reproductive tumors, respectively) were eligible for the present meta-analysis. In the subsequent meta-analysis, the occurrence of vitamin D deficiency in the case and control groups were 52.36% and 48.70%, respectively; women with female reproductive benign and malignant tumors were 55.57% and 50.59%, respectively. Although, no conclusive association was found between vitamin D deficiency and female reproductive tumors (OR, 1.05; 95% CI, 0.85-1.31); vitamin D deficiency may be a risk factor of malignant female reproductive neoplasm, as shown by the pooled OR (95% CI):1.17 (1.02-1.33). Furthermore, based on the OR values, association of vitamin D insufficiency with disease type, study location, number of patients, and methods for detecting CLA was observed. Similar results in the sensitivity analysis were observed. TSA showed that the cumulative Z-curve crossed the traditional boundary line, rather than crossing the trial sequential monitoring boundary. However, the cumulative information failed to reach the required information size. CONCLUSIONS Currently, vitamin D deficiency appears to be a common issue in females, and there may be an urgent need to improve the level of vitamin D. Furthermore, vitamin D deficiency may be a non-negligible risk factor of malignant female reproductive neoplasm. Undoubtedly, more trials are required in the future according to TSA.
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Affiliation(s)
- Lina Yan
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing
| | - Yun Gu
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing
| | - Ting Luan
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing
| | - Miao Miao
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing
| | - Lisha Jiang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Medical University of Anhui, Hefei, China
| | - Yu Liu
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing
| | - Ping Li
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing
| | - Xin Zeng
- The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing
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27
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Gilissen L, Huygens S, Goossens A. Allergic contact dermatitis caused by calcipotriol. Contact Dermatitis 2017; 78:139-142. [DOI: 10.1111/cod.12910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/19/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Liesbeth Gilissen
- Contact Allergy Unit, Department of Dermatology; University Hospitals KU Leuven; 3000 Leuven Belgium
| | - Sara Huygens
- Contact Allergy Unit, Department of Dermatology; University Hospitals KU Leuven; 3000 Leuven Belgium
| | - An Goossens
- Contact Allergy Unit, Department of Dermatology; University Hospitals KU Leuven; 3000 Leuven Belgium
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28
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Patel NU, Felix K, Reimer D, Feldman SR. Calcipotriene/betamethasone dipropionate for the treatment of psoriasis vulgaris: an evidence-based review. Clin Cosmet Investig Dermatol 2017; 10:385-391. [PMID: 29033598 PMCID: PMC5628677 DOI: 10.2147/ccid.s131727] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
While topical medications remain the cornerstone of the psoriasis treatment paradigm, they also come with the risk of multiple side effects. An alternative topical treatment option, calcipotriene or calcipotriol, is a vitamin D derivative that is thought to work by inhibiting keratinocyte proliferation and enhancing keratinocyte differentiation. Multiple studies have demonstrated its efficacy and safety in improving psoriasis when used in combination with topical corticosteroids. Given the effectiveness and side effect profile seen with this combination of topical steroid and calcipotriene, the US Food and Drug Administration approved a calcipotriene/betamethasone dipropionate product for use in psoriasis patients over the age of 12 in 2006. Our paper seeks to review clinical trial evidence of this combination medication and its use in the treatment of psoriasis vulgaris. While assessment of available evidence indicates that the topical medication is both safe and effective for the treatment of psoriasis vulgaris, addressing limitations of what is known, such as tolerability, adherence, and patient preference, of this combination drug in future high-impact studies is needed.
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Affiliation(s)
- Nupur U Patel
- Center for Dermatology Research, Department of Dermatology
| | - Kayla Felix
- Center for Dermatology Research, Department of Dermatology
| | | | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology.,Department of Pathology.,Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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