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Rudnicka L, Olszewska M, Goldust M, Waśkiel-Burnat A, Warszawik-Hendzel O, Dorożyński P, Turło J, Rakowska A. Efficacy and Safety of Different Formulations of Calcipotriol/Betamethasone Dipropionate in Psoriasis: Gel, Foam, and Ointment. J Clin Med 2021; 10:jcm10235589. [PMID: 34884291 PMCID: PMC8658256 DOI: 10.3390/jcm10235589] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 12/11/2022] Open
Abstract
Preparations containing calcipotriol combined with betamethasone dipropionate (in the forms of ointment, gel, and foam) are available for the topical treatment of psoriasis. This review summarizes the differences in the efficacy and safety of these formulations, as well as the preferences of patients with various forms of psoriasis (plaque, scalp, and nail psoriasis). It has been documented that foams provide higher bioavailability, resulting in increased efficacy in plaque psoriasis compared to ointments and gels. Gels or foams are preferred by patients for their different practical qualities (e.g., gels for “easy application”, and foams for “immediate relief”). The available data indicate that ointments may be the most effective formulation in nail psoriasis, and gels are preferred by patients with scalp psoriasis because of their cosmetic features. Treatment with a foam formulation is associated with a lower number of medical appointments compared to treatment with an ointment and with a lower probability of developing indications for systemic treatment. The safety profiles of foams, ointments, and gels are comparable, with the most common adverse effect being pruritus at the application site (in 5.8% of the patients). A long-term proactive maintenance therapy markedly reduces the number of relapses and is likely to close the gap between topical and systemic treatment in psoriasis.
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Affiliation(s)
- Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (M.O.); (A.W.-B.); (O.W.-H.); (A.R.)
- Correspondence: ; Tel.: +48-225021324; Fax: +48-228242200
| | - Małgorzata Olszewska
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (M.O.); (A.W.-B.); (O.W.-H.); (A.R.)
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, 55122 Mainz, Germany;
| | - Anna Waśkiel-Burnat
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (M.O.); (A.W.-B.); (O.W.-H.); (A.R.)
| | - Olga Warszawik-Hendzel
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (M.O.); (A.W.-B.); (O.W.-H.); (A.R.)
| | - Przemysław Dorożyński
- Department of Drug Technology and Pharmaceutical Biotechnology, Medical University of Warsaw, 02-097 Warsaw, Poland; (P.D.); (J.T.)
| | - Jadwiga Turło
- Department of Drug Technology and Pharmaceutical Biotechnology, Medical University of Warsaw, 02-097 Warsaw, Poland; (P.D.); (J.T.)
| | - Adriana Rakowska
- Department of Dermatology, Medical University of Warsaw, 02-008 Warsaw, Poland; (M.O.); (A.W.-B.); (O.W.-H.); (A.R.)
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Elmets CA, Korman NJ, Prater EF, Wong EB, Rupani RN, Kivelevitch D, Armstrong AW, Connor C, Cordoro KM, Davis DMR, Elewski BE, Gelfand JM, Gordon KB, Gottlieb AB, Kaplan DH, Kavanaugh A, Kiselica M, Kroshinsky D, Lebwohl M, Leonardi CL, Lichten J, Lim HW, Mehta NN, Paller AS, Parra SL, Pathy AL, Siegel M, Stoff B, Strober B, Wu JJ, Hariharan V, Menter A. Joint AAD-NPF Guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures. J Am Acad Dermatol 2020; 84:432-470. [PMID: 32738429 DOI: 10.1016/j.jaad.2020.07.087] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 01/23/2023]
Abstract
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the United States population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.
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Affiliation(s)
| | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Emily B Wong
- San Antonio Uniformed Services Health Education Consortium, Joint-Base San Antonio, Texas
| | - Reena N Rupani
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco, California
| | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | | | - Matthew Kiselica
- Patient Advocate, National Psoriasis Foundation, Portland, Oregon
| | | | - Mark Lebwohl
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Jason Lichten
- Patient Advocate, National Psoriasis Foundation, Portland, Oregon
| | - Henry W Lim
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Nehal N Mehta
- The National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Arun L Pathy
- Colorado Permanente Medical Group, Centennial, Colorado
| | - Michael Siegel
- Pediatric Dermatology Research Alliance, Indianapolis, Indiana
| | | | - Bruce Strober
- Central Connecticut Dermatology Research, Cromwell, Connecticut; Yale University, New Haven, Connecticut
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, California
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Megna M, Cinelli E, Camela E, Fabbrocini G. Calcipotriol/betamethasone dipropionate formulations for psoriasis: an overview of the options and efficacy data. Expert Rev Clin Immunol 2020; 16:599-620. [PMID: 32476507 DOI: 10.1080/1744666x.2020.1776116] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Psoriasis is a very common chronic inflammatory skin disease affecting up to 3% of the general population with 75% of the psoriasis subjects being affected by a mild form of disease. Hence, topical therapy is the most frequent employed treatment in psoriasis also because it can be easily combined with systemic therapy. In this context, calcipotriol/betamethasone dipropionate (Cal/BD) fixed-dose association represents the first-line treatment due to its efficacy and once-daily application. Different Cal/BD formulations, such as ointment, gel (topical suspension), and aerosol foam, are approved by US Food and Drug Administration. AREAS COVERED For this review, relevant English literature (trials, real-life studies, case series, and reviews) regarding Cal/BD different formulations efficacy in psoriasis was searched for through to 28 January 2020. The following database were consulted: PubMed, Embase, the Cochrane Library, Google Scholar, EBSCO, and clinicaltrials.gov. EXPERT OPINION Cal/BD formulations are efficacious treatment for psoriasis. Cal/BD aerosol foam shows a higher efficacy compared to Cal/BD ointment or gel formulations, appearing as a game-changer in psoriasis therapy not only for mild disease but also for moderate psoriasis as well as in selected severe cases in combination with systemic treatments.
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Affiliation(s)
- Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy
| | - Eleonora Cinelli
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy
| | - Elisa Camela
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy
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Gu RL, Wang SQ. Clinical study on treatment of facial seborrheic dermatitis with intense pulsed light combined with 30% supramolecular salicylic acid. Clinics (Sao Paulo) 2020; 75:e1875. [PMID: 33206755 PMCID: PMC7603169 DOI: 10.6061/clinics/2020/e1875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/18/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES In this study, we investigated the effects of intense pulsed light (IPL) combined with 30% supramolecular salicylic acid on facial seborrheic dermatitis. METHODS A total of 45 patients with mild or moderate facial seborrheic dermatitis were selected from our hospital between September 2018 and September 2019. The patients were divided into three groups consisting of 15 patients each. The first group was exposed to a combination of IPL and 30% supramolecular salicylic acid treatment, the second group was exposed to the IPL treatment alone, and the third group was exposed to the 30% supramolecular salicylic acid treatment alone. They were treated once every 4 weeks in three consecutive rounds. RESULTS Facial lesions and symptoms were observed 4 and 12 weeks after the first treatment, and adverse reactions were recorded. The combination group showed significant improvement in symptoms 4 weeks after the first treatment, while the individual treatment groups showed no significant improvement. After three rounds of treatments, seborrheic dermatitis had significantly decreased in the three groups; the efficacy of the combined treatment group was significantly higher than that of the IPL group and the 30% supramolecular salicylic acid group. CONCLUSION IPL combined with 30% supramolecular salicylic acid was effective in the treatment of facial seborrheic dermatitis and provided a quicker result with no adverse reactions.
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Affiliation(s)
- Rui-Long Gu
- Shanghai Huamei Medical Cosmetic Hospital, Shanghai, 200120, China
| | - Shan-Qing Wang
- College of Aesthetic Medicine, Yichun University, Yichun, 336000, China
- *Corresponding author. E-mail:
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Zhao Y, Wang G, Ni W, Song Z, Chen K, Zhang C, Zhang S, Ding Y, Zheng M, Shi Y, Lin Z, Liu X, Zhang X, Zhou Q, Ahmed KD. Visit Adherence of Mild to Moderate Psoriasis Patients: A Mobile-Based Randomized Study. Patient Prefer Adherence 2020; 14:2551-2557. [PMID: 33447016 PMCID: PMC7802013 DOI: 10.2147/ppa.s277103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/10/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE We aimed to prospectively evaluate the visit adherence in mild to moderate psoriasis patients. METHODS Plaque psoriasis patients aged 18 or above who were prescribed with a two-component formula ointment were eligible for the study. The patients were randomly assigned to group A or B, and received management with or without planned patient-doctor communication via a mobile platform. The outpatient visit was scheduled at week 2, 8, 16, 28, 48, and 52. Visit adherence was evaluated as the visit rate of the patients. RESULTS Two hundred twenty-one patients were included. Generally, the visit adherence dropped over time during follow-up. The visit rates in group A were 5.2-15.7% through the 52 weeks, and similar rates were found in group B (7.5-17.0%, vs group A, P > 0.05). A negative binomial regression model showed that older age and higher BSA were correlated with more frequent visits. CONCLUSION The visit adherence of mild to moderate psoriasis patients was very low in China. Proactive inquiries of the doctors via the mobile platform failed to improve the visit adherence of the patients.
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Affiliation(s)
- Yi Zhao
- Department of Dermatology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People’s Republic of China
- Correspondence: Yi ZhaoDepartment of Dermatology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Beijing102218, People’s Republic of China Email
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an, People’s Republic of China
- Gang WangDepartment of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an710032, People’s Republic of China Email
| | - Wenqiong Ni
- Department of Dermatology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Zhiqiang Song
- Department of Dermatology, Southwest Hospital, The Third Military Medical University, Chongqing, People’s Republic of China
| | - Kun Chen
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, People’s Republic of China
| | - Chunlei Zhang
- Department of Dermatology, Peking University Third Hospital, Beijing, People’s Republic of China
| | - Shoumin Zhang
- Department of Dermatology, Henan Provincial People's Hospital, Zhengzhou450003, People’s Republic of China
| | - Yangfeng Ding
- Department of Dermatology, Shanghai Skin Disease Hospital, Shanghai, People’s Republic of China
| | - Min Zheng
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Yulin Shi
- Department of Dermatology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine; Institute of Psoriasis, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Zhimiao Lin
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Xiaomin Liu
- Department of Dermatology, The University of Hong Kong–Shenzhen Hospital, Shenzhen, People’s Republic of China
| | - Xiaofei Zhang
- Department of Clinical Epidemiology and Biostatistics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People’s Republic of China
| | - Qintian Zhou
- Scientific Affairs and MSL Department, LEOPharma China, Shanghai, People’s Republic of China
| | - Kazi Deluwar Ahmed
- Scientific Affairs and MSL Department, LEOPharma China, Shanghai, People’s Republic of China
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Chen Z, Zhou D, Wang Y, Lan H, Duan X, Li B, Zhao J, Li W, Liu Z, Di T, Guo X, Zhang J, Li B, Feng S, Li P. Fire needle acupuncture or moxibustion for chronic plaque psoriasis: study protocol for a randomized controlled trial. Trials 2019; 20:674. [PMID: 31801593 PMCID: PMC6894135 DOI: 10.1186/s13063-019-3736-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/18/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Psoriasis is a chronic, immune-mediated disorder with chronic plaque psoriasis being the primary manifestation during the remission stage. Patients often have a slow course and long history of the disease. The refractory type of psoriasis is a stubborn rash that does not subside easily. We designed this randomized controlled trial to compare the effectiveness and relapse rates of plaque psoriasis in patients treated with either acupuncture, moxibustion or calcipotriol ointment. The ultimate aim of the study is to select an effective traditional Chinese medicine therapy for patients with plaque psoriasis. METHODS The study will be a multicenter, prospective, randomized controlled trial that compares the effectiveness of fire needle therapy, moxibustion and calcipotriol ointment. In total, 160 patients with plaque psoriasis who meet the inclusion criteria will be recruited from three hospitals in Beijing and then randomly assigned to receive either fire needle therapy (group A1), moxibustion (group A2) or calcipotriol ointment (group B). All participants will receive an 8-week treatment and will then be followed up for another 24 weeks, with time points at weeks 12 and 24 after treatment completion. The primary outcomes to be measured are relapse rates and psoriasis area and severity index score of the target lesions. In addition, the target lesion onset time, dermatology life quality index, traditional Chinese medicine syndrome score, and the relapse interval of the target lesion will be measured. Adverse events will be recorded for safety assessment. DISCUSSION The aim of this study is to determine whether fire needle therapy or moxibustion could improve the clinical effectiveness for psoriasis lesions and reduce the relapse rate. Once completed, it will provide information regarding therapeutic evaluation on fire needle therapy or moxibustion for plaque psoriasis, which will assist clinicians in selecting the most effective treatment options for patients. TRIAL REGISTRATION International Clinical Trials Registry Platform (ICTRP), ChiCTR1800019588. Registered on 19 November 2018.
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Affiliation(s)
- Zhaoxia Chen
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
- Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China
| | - Dongmei Zhou
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Yan Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
- Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China
| | - Haibing Lan
- Gulou Hospital of Traditional Chinese Medicine of Beijing, Beijing, 100009, China
| | - Xingwu Duan
- Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Bohua Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Jingxia Zhao
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
- Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China
| | - Wei Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
| | - Zhengrong Liu
- Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Tingting Di
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
- Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China
| | - Xinwei Guo
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
- Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China
| | - Jinchao Zhang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
- Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China
| | - Bo Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China
- Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China
| | - Shuo Feng
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China.
- Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China.
| | - Ping Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, 100010, China.
- Beijing Institute of Traditional Chinese Medicine, Beijing, 100010, China.
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Anderko M, Navarro Triviño FJ, Sharples CL. Calcipotriol Plus Betamethasone Dipropionate Aerosol Foam For Scalp Psoriasis. Clin Cosmet Investig Dermatol 2019; 12:699-705. [PMID: 31571970 PMCID: PMC6756148 DOI: 10.2147/ccid.s221078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/04/2019] [Indexed: 11/23/2022]
Abstract
This article presents real-world experience of the effectiveness of calcipotriol (50 µg/g)/betamethasone dipropionate (0.5 mg/g) (Cal/BD) aerosol foam formulation in three cases of scalp psoriasis, and briefly reviews the literature relating to Cal/BD topical therapy in adults with scalp psoriasis. Patients had long histories of scalp psoriasis and reported negative impacts on their lives (e.g. clothing choices, psychological well-being, employment status). Previous treatments had provided inadequate or only temporary relief. Cal/BD aerosol foam relieved itching in the first few days and was associated with visible improvement of flaky patches on the scalp at the end of the recommended 4-week treatment period. Controlled clinical trials in patients with scalp psoriasis are rare. There have been several trials in adults with scalp psoriasis involving Cal/BD gel or suspension scalp formulations, which have proven more effective and well tolerated compared with the individual components or vehicle alone. The Cal/BD aerosol formulation has enhanced skin penetration and higher bioavailability compared with the older formulations; studies show improved efficacy with Cal/BD aerosol foam, compared with older formulations, in patients with plaque psoriasis. The present cases confirm the benefits of Cal/BD aerosol foam in adults with scalp psoriasis, treated in real-world settings.
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Yap FB. The Role of Combination Calcipotriol plus Betamethasone Dipropionate Gel in the Treatment of Moderate-to-Severe Scalp Seborrhoeic Dermatitis. Sultan Qaboos Univ Med J 2019; 18:e520-e523. [PMID: 30988973 DOI: 10.18295/squmj.2018.18.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/04/2018] [Accepted: 09/20/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives This study aimed to investigate the off-label use of a combination calcipotriol plus betamethasone dipropionate (CBD) gel in the treatment of moderate-to-severe scalp seborrhoeic dermatitis (SSD). Methods This retrospective study involved 32 patients with SSD who were prescribed CBD gel at the Subang Jaya Medical Centre, Selangor, Malaysia, between January 2016 and December 2017. The Physician Global Assessment Scale was used to assess disease severity. Itching/discomfort was evaluated using a visual analogue scale. Results The mean age was 35.8 ± 6.9 years. Severe disease was seen in 53.1%. Complete clearance was recorded in 15.6%, 40.6% and 59.4% of patients at weeks two, six and 10, respectively. By week 10, 87.5% had achieved marked improvement. Both mean itching and discomfort scores significantly improved at weeks two, six and 10 (P <0.001). Better outcomes were significantly associated with disease duration and itching intensity and discomfort at presentation (P <0.050). Conclusion CBD gel should be considered as an option for SSD cases not adequately controlled by prior conventional treatment.
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Affiliation(s)
- Felix B Yap
- Department of Medicine, Faculty of Medicine & Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
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Psoriasis in Skin of Color: Insights into the Epidemiology, Clinical Presentation, Genetics, Quality-of-Life Impact, and Treatment of Psoriasis in Non-White Racial/Ethnic Groups. Am J Clin Dermatol 2018; 19:405-423. [PMID: 29209945 DOI: 10.1007/s40257-017-0332-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Psoriasis is a chronic inflammatory skin condition affecting diverse racial/ethnic groups throughout the world. Large population-based studies suggest that psoriasis occurs most often in individuals of European ancestry, followed by black and Hispanic individuals, although the true prevalence of psoriasis in non-white individuals is likely underestimated. Despite similarities in psoriasis between ethnic groups, there are notable differences in the presentation, quality-of-life impact, and treatment of psoriasis with important implications for the management of non-white individuals. Overall, heterogeneity in psoriasis susceptibility alleles, in combination with cultural and socioeconomic factors, may explain these differences. In this article, we review the epidemiology, clinical presentation, genetic polymorphisms, quality-of-life impact, and treatment nuances of psoriasis in patients with skin of color.
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Abstract
BACKGROUND Scalp psoriasis is commonly the initial presentation of psoriasis, and almost 80 % of patients with psoriasis will eventually experience it. OBJECTIVE Although several systematic reviews and guidelines exist, an up-to-date evidence-based review including more recent progress on the use of biologics and new oral small molecules was timely. METHODS Of the 475 studies initially retrieved from PubMed and the 845 from Embase (up to May 2016), this review includes 27 clinical trials, four papers reporting pooled analyses of other clinical trials, ten open-label trials, one case series, and two case reports after excluding non-English literature. RESULTS To our knowledge, few randomized controlled trials (RCTs) are conducted specifically in scalp psoriasis. Topical corticosteroids provide good effects and are usually recommended as first-line treatment. Calcipotriol-betamethasone dipropionate is well tolerated and more effective than either of its individual components. Localized phototherapy is better than generalized phototherapy on hair-bearing areas. Methotrexate, cyclosporine, fumaric acid esters, and acitretin are well-recognized agents in the treatment of psoriasis, but we found no published RCTs evaluating these agents specifically in scalp psoriasis. Biologics and new small-molecule agents show excellent effects on scalp psoriasis, but the high cost of these treatments mean they may be limited to use in extensive scalp psoriasis. CONCLUSIONS More controlled studies are needed for an evidence-based approach to scalp psoriasis.
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