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Pinter A, Tsianakas A, Eichner A. Efficacy and Safety of Topical Tacrolimus Microemulsion Applied Twice Daily in Patients with Mild to Moderate Scalp Psoriasis. Dermatol Ther (Heidelb) 2024; 14:521-532. [PMID: 38345680 PMCID: PMC10891015 DOI: 10.1007/s13555-024-01102-6] [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: 12/01/2023] [Accepted: 01/15/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Involvement of the scalp is common in psoriasis and severely affects the quality of life of those affected. It is difficult to treat and places special demands on the galenics of a drug formulation. Tacrolimus is a calcineurin inhibitor and is approved as an ointment formulation for the treatment of atopic dermatitis. The efficacy and safety of topically applied tacrolimus have also been studied and proven for psoriasis. However, no proprietary pharmaceutical product is currently approved for this indication. METHODS A multicenter, double-blind, vehicle-controlled phase 3 study was conducted to evaluate the efficacy and safety of 0.1% tacrolimus microemulsion when applied topically twice daily in 128 patients independently of sex with scalp psoriasis. RESULTS The primary efficacy analysis showed a scalp Investigator Global Assessment (s-IGA) of 0 (absence of disease) or 1 (very mild disease) at 8 weeks in 28.6% of subjects in the tacrolimus group, indicating a significantly better response (p = 0.0476, chi-square test) versus 12.7% of subjects in the placebo group (difference of 15.9%-points). The Dermatology Life Quality Index (DLQI) improved over time and was more pronounced in the group treated with tacrolimus-containing microemulsion than in the placebo group, but showed no statistically significant difference after 8 weeks of use (p = 0.193, ANCOVA). The safety analysis revealed no evidence of cutaneous side effects other than those known. Toxicologically relevant serum levels of tacrolimus could be excluded. CONCLUSION The study data show that 0.1% tacrolimus microemulsion has good efficacy and safety in the treatment of scalp psoriasis.
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Affiliation(s)
- Andreas Pinter
- Clinic for Dermatology, Venereology and Allergy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Adina Eichner
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06097, Halle (Saale), Germany.
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Shi HJ, Zhou H, Ma AL, Wang L, Gao Q, Zhang N, Song HB, Bo KP, Ma W. Oxymatrine therapy inhibited epidermal cell proliferation and apoptosis in severe plaque psoriasis. Br J Dermatol 2019; 181:1028-1037. [PMID: 30822359 PMCID: PMC6899633 DOI: 10.1111/bjd.17852] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2019] [Indexed: 01/02/2023]
Abstract
Background Psoriasis is a chronic skin disorder that manifests as epidermal keratinocyte hyperplasia. Objectives We examined the effect of oxymatrine treatment on cell proliferation and apoptosis in skin lesions of psoriasis. Patients and methods Patients with severe plaque psoriasis were treated with oxymatrine or with acitretin. The skin lesions were stained with proliferating cell nuclear antigen (PCNA), Ki‐67 and Bcl‐2, as well as examined by terminal deoxynucleotidyl transferase‐mediated dUTP nick‐end labelling (TUNEL). We performed correlations of the Psoriasis Area and Severity Index (PASI) and the proliferation and apoptosis index. Results Oxymatrine significantly reduced the psoriasis lesions as demonstrated by the reduced PASI score after treatment [6·91; 95% confidence interval (CI) 5·00–8·81, P < 0·001]. In the oxymatrine group, the mitotic index was 26·15 (95% CI 24·80–27·49) before oxymatrine treatment, decreasing to 14·52 (95% CI 13·82–15·25; P < 0·001) after treatment, but remained higher than the normal group (6·24; 95% CI 5·87–6·61, P < 0·001). Oxymatrine also inhibited the proliferation of epidermal cells in the skin lesion as indicated by the reduced proliferation index after treatment (P < 0·01). In addition, oxymatrine treatment reduced cellular apoptosis as shown by increased Bcl‐2 expression and a decrease in TUNEL‐positive cells. The PASI score was positively correlated with mitotic index, proliferation index and apoptotic index (TUNEL), but negatively correlated with Bcl‐2 expression. Conclusions Oxymatrine treatment reduced proliferation but inhibited apoptosis of cells in the skin lesion. The balance between cell proliferation and turnover may contribute to the significant alleviation of psoriasis by oxymatrine. What's already known about this topic? Psoriasis manifests as epidermal keratinocyte hyperplasia with proliferation, keratinocyte maturation and turnover rates. Current drugs for psoriasis may inhibit cell proliferation but could not adjust the balance of cell division, differentiation and apoptosis.
What does this study add? We studied the efficacy of oxymatrine in the treatment of psoriasis and analysed the correlation of skin lesions, proliferation and apoptosis index before and after oxymatrine treatment.
What is the translational message? Our study has demonstrated that oxymatrine is effective in the treatment of severe plaque psoriasis. It has comparable efficacy with acitretin. Because acitretin treatment was sometimes associated with metabolic abnormalities, our study suggests oxymatrine therapy as an alternative treatment for psoriasis in the context of acitretin allergy or adverse reactions.
https://www.bjdonline.com/article/oxymatrine-therapy-inhibited-epidermal-cell-proliferation-and-apoptosis-in-severe-plaque-psoriasis/ Linked Comment: https://doi.org/10.1111/bjd.18299.
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Affiliation(s)
- H-J Shi
- Department of Dermatovenereology, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - H Zhou
- Department of Dermatovenereology, Muping Traditional Chinese Medicine Hospital, Yantai, 264100, China
| | - A-L Ma
- Department of Dermatovenereology, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - L Wang
- Department of Dermatovenereology, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Q Gao
- Department of Dermatovenereology, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - N Zhang
- Department of Dermatovenereology, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - H-B Song
- Department of Dermatovenereology, Ningxia Medical University, Yinchuan, China
| | - K-P Bo
- Department of Dermatovenereology, Ningxia Medical University, Yinchuan, China
| | - W Ma
- Department of Dermatovenereology, Ningxia Medical University, Yinchuan, China
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Gladman DD, Poulin Y, Adams K, Bourcier M, Barac S, Barber K, Chandran V, Dutz J, Flanagan C, Gooderham MJ, Gulliver WP, Ho VC, Hong CH, Karsh J, Khraishi MM, Lynde CW, Papp KA, Rahman P, Rohekar S, Rosen CF, Russell AS, Vender RB, Yeung J, Ziouzina O, Zummer M. Treating Psoriasis and Psoriatic Arthritis: Position Paper on Applying the Treat-to-target Concept to Canadian Daily Practice. J Rheumatol 2017; 44:519-534. [DOI: 10.3899/jrheum.161473] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective.To develop preliminary treat-to-target (T2T) recommendations for psoriasis and psoriatic arthritis (PsA) for Canadian daily practice.Methods.A task force composed of expert Canadian dermatologists and rheumatologists performed a needs assessment among Canadian clinicians treating these diseases as well as an extensive literature search on the outcome measures used in clinical trials and practice.Results.Based on results from the needs assessment and literature search, the task force established 5 overarching principles and developed 8 preliminary T2T recommendations.Conclusion.The proposed recommendations should improve management of psoriasis and PsA in Canadian daily practice. However, these recommendations must be further validated in a real-world observational study to ensure that their use leads to better longterm outcomes.
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Reich K, Leonardi C, Lebwohl M, Kerdel F, Okubo Y, Romiti R, Goldblum O, Dennehy EB, Kerr L, Sofen H. Sustained response with ixekizumab treatment of moderate-to-severe psoriasis with scalp involvement: results from three phase 3 trials (UNCOVER-1, UNCOVER-2, UNCOVER-3). J DERMATOL TREAT 2016; 28:282-287. [DOI: 10.1080/09546634.2016.1249820] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Kristian Reich
- Dermatologikum Hamburg and SCIderm GmbH, Hamburg, Germany
| | - Craig Leonardi
- Department of Dermatology, Saint Louis University School of Medicine, St Louis, MO, USA
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Yukari Okubo
- Department of Dermatology, Tokyo Medical University, Shinjuku, Tokyo, Japan
| | - Ricardo Romiti
- Department of Dermatology Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Lisa Kerr
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Howard Sofen
- Department of Medicine, Division of Dermatology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Molecular and Cellular Profiling of Scalp Psoriasis Reveals Differences and Similarities Compared to Skin Psoriasis. PLoS One 2016; 11:e0148450. [PMID: 26849645 PMCID: PMC4743842 DOI: 10.1371/journal.pone.0148450] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 01/18/2016] [Indexed: 01/02/2023] Open
Abstract
Scalp psoriasis shows a variable clinical spectrum and in many cases poses a great therapeutic challenge. However, it remains unknown whether the immune response of scalp psoriasis differs from understood pathomechanisms of psoriasis in other skin areas. We sought to determine the cellular and molecular phenotype of scalp psoriasis by performing a comparative analysis of scalp and skin using lesional and nonlesional samples from 20 Caucasian subjects with untreated moderate to severe psoriasis and significant scalp involvement and 10 control subjects without psoriasis. Our results suggest that even in the scalp, psoriasis is a disease of the inter-follicular skin. The immune mechanisms that mediate scalp psoriasis were found to be similar to those involved in skin psoriasis. However, the magnitude of dysregulation, number of differentially expressed genes, and enrichment of the psoriatic genomic fingerprint were more prominent in skin lesions. Furthermore, the scalp transcriptome showed increased modulation of several gene-sets, particularly those induced by interferon-gamma, compared with that of skin psoriasis, which was mainly associated with activation of TNFα/L-17/IL-22-induced keratinocyte response genes. We also detected differences in expression of gene-sets involving negative regulation, epigenetic regulation, epidermal differentiation, and dendritic cell or Th1/Th17/Th22-related T-cell processes.
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Papadavid E, Ferra D, Koumaki D, Dalamaga M, Stamou C, Theodoropoulos K, Rigopoulos D. Ustekinumab Induces Fast Response and Maintenance of Very Severe Refractory Scalp Psoriasis: Results in Two Greek Patients from the Psoriasis Hospital-Based Clinic. Dermatology 2014; 228:107-11. [DOI: 10.1159/000357030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 10/28/2013] [Indexed: 11/19/2022] Open
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Strober BE, Clay Cather J, Cohen D, Crowley JJ, Gordon KB, Gottlieb AB, Kavanaugh AF, Korman NJ, Krueger GG, Leonardi CL, Schwartzman S, Sobell JM, Solomon GE, Young M. A Delphi Consensus Approach to Challenging Case Scenarios in Moderate-to-Severe Psoriasis: Part 1. Dermatol Ther (Heidelb) 2012; 2:1. [PMID: 23205324 PMCID: PMC3510391 DOI: 10.1007/s13555-012-0001-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Traditional clinical trials in psoriasis exclude a significant proportion of patients with complex disease and comorbidities. A consensus panel of 14 experts in the field of psoriasis was formed to conduct a Delphi method exercise to identify difficult-to-treat psoriasis clinical scenarios and to rank treatment approaches. METHODS The exercise consisted of both survey questionnaires and a live meeting to review and discuss current data (as of 2009, when the exercise was conducted) and arrive at a consensus for optimal treatment options. Seventy difficult treatment scenarios were identified, and the top 24 were selected for discussion at the live meeting. RESULTS Six of the 24 discussed case scenarios are presented in this article (another five are presented in Part 2): (1) psoriasis with human papilloma virus-induced cervical or anogenital dysplasia; (2) concomitant psoriasis and systemic lupus erythematosus; (3) severe psoriatic nail disease causing functional or emotional impairment; (4) psoriasis therapies that potentially reduce cardiovascular morbidity and mortality; (5) older patients (≥65 years of age) with psoriasis; and (6) severe scalp psoriasis that is unresponsive to topical therapy. CONCLUSION The Delphi exercise resulted in guidelines for practicing physicians to utilize when confronted with challenging patients with psoriasis.
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Affiliation(s)
- Bruce E. Strober
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT 06032 USA
| | - Jennifer Clay Cather
- Division of Dermatology, Department of Internal Medicine, Baylor University Medical Center, and Modern Dermatology, Dallas, TX USA
| | - David Cohen
- Department of Dermatology, NYU Langone Medical Center, New York, USA
| | - Jeffrey J. Crowley
- Bakersfield Dermatology and Skin Cancer Medical Group, Bakersfield, CA USA
| | - Kenneth B. Gordon
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Alice B. Gottlieb
- Department of Dermatology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA USA
| | - Arthur F. Kavanaugh
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of California, San Diego, CA USA
| | - Neil J. Korman
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, OH USA
| | - Gerald G. Krueger
- Department of Dermatology, University of Utah, Salt Lake City, UT USA
| | - Craig L. Leonardi
- Department of Dermatology, St. Louis University School of Medicine, St. Louis, MO USA
| | - Sergio Schwartzman
- Weill Medical College of Cornell University, Hospital for Special Surgery, New York Presbyterian Hospital, New York, NY USA
| | - Jeffrey M. Sobell
- Department of Dermatology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA USA
| | - Gary E. Solomon
- Department of Rheumatology, NYU Langone School of Medicine, New York, NY USA
| | - Melodie Young
- University of Texas at Arlington, Graduate School of Nursing, and Modern Dermatology, Dallas, TX USA
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Abstract
Treatment modalities and therapeutic response experience support the use of immunotherapy in the treatment of many diseases in all fields of medicine. The aim of this article is to conduct and present a review of literature on the use of immunotherapy in the treatment of skin diseases analyzing scientific literature available up to January 2012. Studies that presented evidence-based data were selected. The article discusses how blocking or reverting the effect of a specific immunologic disequilibrium can treat dermatoses and intends to transfer a large amount of immunotherapy knowledge into a historical perspective for physicians naive to immunotherapy practices.
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Affiliation(s)
- Robyn S Fallen
- Michael G. DeGroote School of Medicine, Waterloo Regional Campus, McMaster University, 10-B Victoria Street South, Kitchener, Ontario N2G 1C5, Canada
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Wozel G, Meurer M. Zehn Jahre Biologics in der Dermatologie. Hautarzt 2012; 63 Suppl 1:53-8. [DOI: 10.1007/s00105-011-2296-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bagel J, Lynde C, Tyring S, Kricorian G, Shi Y, Klekotka P. Moderate to severe plaque psoriasis with scalp involvement: a randomized, double-blind, placebo-controlled study of etanercept. J Am Acad Dermatol 2011; 67:86-92. [PMID: 22014541 DOI: 10.1016/j.jaad.2011.07.034] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 06/29/2011] [Accepted: 07/08/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Biologic therapies are used to treat moderate to severe psoriasis, but evidence from randomized, controlled studies is lacking regarding scalp-related effectiveness. OBJECTIVE To evaluate the efficacy and safety of etanercept for scalp symptoms (erythema, induration, scale, and percentage of scalp involvement) in patients with moderate to severe plaque psoriasis and scalp involvement. METHODS In this randomized, placebo-controlled study, adult patients with stable plaque psoriasis and significant scalp symptoms received etanercept 50 mg twice weekly (BIW) by subcutaneous injection (SC) for 12 weeks, followed by etanercept 50 mg once weekly (QW) and placebo QW (Group A, n = 62) or SC placebo BIW for 12 weeks, followed by etanercept 50 mg BIW for 12 weeks (Group B, n = 62). The primary end point was percentage change in Psoriasis Scalp Severity Index (PSSI) at week 12. RESULTS Demographics and disease characteristics were balanced: 56% men, 73% white, median age 41 years, median BMI 30.2 kg/m(2). At week 12, mean PSSI improvement was 86.8% (standard deviation [SD], 18.0%) in Group A and 20.4% (SD, 39.3%) in Group B (P < .0001). At week 24, mean PSSI improvements were as follows: Group A, 90.6% (SD 13.1%); Group B, 79.1% (SD 33.6%). At week 12, 51 of 59 (86%) Group A patients and 7 of 61 (11%) Group B patients achieved PSSI 75 (P <.0001). Three patients (2.7%) reported 5 serious adverse events: cholecystitis/cholelithiasis, fall/rib fracture, and metastatic malignant melanoma. LIMITATIONS The study was insufficiently powered to detect rare adverse events potentially associated with etanercept. CONCLUSIONS Etanercept is an effective, well-tolerated treatment for plaque psoriasis involving the scalp.
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Affiliation(s)
- Jerry Bagel
- Psoriasis Treatment Center of Central New Jersey, East Windsor, New Jersey 08520, USA.
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Puig L, Ribera M, Hernanz J, Belinchón I, Santos-Juanes J, Linares M, Querol I, Colomé E, Caballé G. Tratamiento de la psoriasis del cuero cabelludo. Revisión de la evidencia y Consenso Delphi del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2010.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
IMPORTANCE OF THE FIELD The use of biologics that target a subset of immune cells in the treatment of immune-mediated ailments is an emerging field. Alefacept is one of the first biologics in the treatment of psoriasis. It selectively reduces CD45RO(+) memory T cells and inhibits T-cell activation. Clinical data support its safety and efficacy in a substantial subset of patients with psoriasis. AREAS COVERED IN THIS REVIEW This article reviews the mechanism of action and the pharmacokinetic and pharmacodynamic properties of alefacept. It also presents the available data about its effectiveness, modes of treatment as well as safety and efficacy in the treatment of psoriasis and other immune-based dermatologic disorders. WHAT THE READER WILL GAIN An overview of the published data about the clinical and adverse effects of alefacept in the treatment of psoriasis and a myriad of immunologically-based disorders. TAKE HOME MESSAGE Ongoing literature supports that alefacept is a safe alternative for the treatment of psoriasis. However, it remains the least prescribed medication in this group of drugs, mainly because it is only effective in a small proportion of patients. Nonetheless, its long-lasting effects and tolerability make it an excellent choice for those who do respond.
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Affiliation(s)
- Jinan Chaarani
- Department of Dermatology, Mount Sinai School of Medicine, 5 East 98th Street, NY 10029, USA
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Takahashi MD, Chouela EN, Dorantes GL, Roselino AM, Santamaria J, Allevato MA, Cestari T, de Aillaud MEM, Stengel FM, Licu D. Efalizumab in the Treatment of Scalp, Palmoplantar and Nail Psoriasis: Results of a 24-Week Latin American Study. ACTA ACUST UNITED AC 2010; 3:1-8. [PMID: 20428227 PMCID: PMC2855826 DOI: 10.1111/j.1753-5174.2009.00025.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction Plaque-type psoriasis affecting the nails, scalp, hands or feet can often be difficult to treat; for example, topical treatments and phototherapy may not penetrate the nail plate or scalp. The objective of this large, international, multicentre study was to investigate the efficacy of efalizumab in a Latin American population of adult patients with moderate-to-severe chronic plaque psoriasis who were candidates for systemic therapy or phototherapy. Methods Eligible patients were enrolled in a 24-week, open-label, single-arm, Phase IIIb/IV study of continuous treatment with subcutaneous efalizumab, 1.0 mg/kg/wk. Involvement of the nails, scalp, or hands or feet was assessed using the Nail Psoriasis Severity Index (NAPSI), the Psoriasis Scalp Severity Index (PSSI), or the Palmoplantar Pustulosis Psoriasis Area and Severity Index (PPPASI), respectively. Missing data were handled using a last observation carried forward or nonresponder imputation approach. Results Of the 189 patients who received treatment, 112 patients had nail involvement, 172 had scalp involvement, and 19 had palmoplantar disease at baseline. At Week 24, ≥50% improvement on the NAPSI, PSSI and PPPASI was observed in 31%, 71% and 68% of patients, respectively, whereas ≥75% improvement on these scores was observed in 17%, 52% and 63%, respectively. Descriptive statistics showed lower NAPSI-75 and higher PSSI-75 and -50 response rates among patients with higher baseline scores. Conclusions This open-label, uncontrolled study provides supportive evidence of the potential of efalizumab as a treatment for nail, scalp and palmoplantar psoriasis.
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Affiliation(s)
| | | | | | | | | | | | - Tania Cestari
- Universidade Federal de Porto Alegre, Hospital de ClínicasPorto Alegre, Brazil
| | | | - Fernando Miguel Stengel
- Centro de Educacion Médica e Investigaciones (CEMIC), Clinicas “Norberto Quirno”Buenos Aires, Argentina
| | - Daiana Licu
- Merck Serono International S.A., Geneva, Switzerland, an affiliate of Merck KGaADarmstadt, Germany
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Puig L, Ribera M, Hernanz J, Belinchón I, Santos-Juanes J, Linares M, Querol I, Colomé E, Caballé G. Treatment of Scalp Psoriasis: Review of the Evidence and Delphi Consensus of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70730-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ortonne J, Chimenti S, Luger T, Puig L, Reid F, Trüeb RM. Scalp psoriasis: European consensus on grading and treatment algorithm. J Eur Acad Dermatol Venereol 2009; 23:1435-44. [PMID: 19614856 DOI: 10.1111/j.1468-3083.2009.03372.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The scalp is a common site of involvement of psoriasis and, for many patients, is a challenging aspect of their disease. This can be attributed not only to the scaling, itching and cosmetic embarrassment that go with scalp psoriasis, but also to the fact that the scalp skin is relatively inaccessible, making topical therapies difficult to apply. The proximity of sensitive facial skin can also limit the use of potentially irritating topical treatments. Nevertheless, the specific challenges of scalp psoriasis are often neglected by treatment guidelines. This paper summarizes the discussions that took place at an international conference of experts convened in Geneva, Switzerland, in March 2008. The objective of the meeting was to review the available treatments for scalp psoriasis in terms of efficacy, safety, convenience, and the implications for patient compliance with treatment. In addition, definitions of mild, moderate and severe scalp psoriasis were agreed. This paper presents a treatment algorithm that includes recommendations for patients in all three categories. It considers the role of potent topical corticosteroids, vitamin D3 derivatives, salicylic acid preparations, and photo- and radiotherapy, as well as systemic therapies, including newer biological agents, for patients with widespread psoriasis with scalp involvement. Data from clinical trials indicate that a potent topical corticosteroid in a short-contact formulation is the most appropriate treatment for most patients with scalp psoriasis.
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Affiliation(s)
- Jp Ortonne
- Centre Hospitalier Universitaire de Nice, Nice, France
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Treatment of severe scalp psoriasis: From the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol 2009; 60:962-71. [DOI: 10.1016/j.jaad.2008.11.890] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Revised: 11/10/2008] [Accepted: 11/17/2008] [Indexed: 11/19/2022]
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Kapoor S. Alefacept: A rapidly expanding role in the management of dermatologic diseases. J DERMATOL TREAT 2009; 20:3. [DOI: 10.1080/09546630802287009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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