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Ávalos-Viveros M, Esquivel-García R, García-Pérez M, Torres-García E, Bartolomé-Camacho MC, Santes V, García-Pérez ME. Updated view of tars for psoriasis: what have we learned over the last decade? Int J Dermatol 2023; 62:290-301. [PMID: 35398899 DOI: 10.1111/ijd.16193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/15/2022] [Accepted: 03/20/2022] [Indexed: 12/01/2022]
Abstract
Tars are one of the most effective, unknown, and oldest therapies for psoriasis. They include coal tar (CT) and biomass-derived products. These treatments, particularly the CT, have proven to be cost-effective with long remission times compared to other systemic or topical treatments. However, they have hardly evolved in recent years, as they are not well-embraced by clinicians or patients because of concerns regarding cosmesis and safety. This review summarizes current knowledge about the chemical characterization, mechanism of action, toxicity, and clinical studies supporting the use of tars for psoriasis over the last decade. Trends within these above aspects are reviewed, and avenues of research are identified. CT is rich in polycyclic aromatic hydrocarbons, whereas biomass-derived tars are rich in phenols. While the activation of the aryl hydrocarbon receptor is involved in the antipsoriatic effect of CT, the mechanism of action of biomass-derived products remains to be elucidated. No conclusive evidence exists about the risk of cancer in psoriasis patients under CT treatment. Large, randomized, double-blind, controlled clinical trials are necessary to promote the inclusion of tars as part of modern therapies for psoriasis.
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Affiliation(s)
- Miguel Ávalos-Viveros
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Mexico
| | - Roberto Esquivel-García
- Facultad de Químico-Farmacobiología, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Mexico
| | - Manuel García-Pérez
- Biological Systems Engineering Department, Washington State University, Pullman, USA
| | - Enelio Torres-García
- Biomass Conversion Division, Instituto Mexicano del Petróleo, Ciudad de México, Mexico
| | | | - Víctor Santes
- Departamento de Biociencias e Ingeniería, Centro Interdisciplinario de Investigaciones y Estudios sobre Medio Ambiente y Desarrollo (CIEMAD), Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Martha-Estrella García-Pérez
- Instituto de Investigaciones Químico-Biológicas, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Mexico
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Draelos ZD. The Efficacy and Tolerability of Turmeric and Salicylic Acid in Psoriasis Treatment. Psoriasis (Auckl) 2022; 12:63-71. [PMID: 35516971 PMCID: PMC9064175 DOI: 10.2147/ptt.s360448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/21/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Patients and Methods Results Conclusion
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Affiliation(s)
- Zoe Diana Draelos
- Dermatology Consulting Services, PLLC, High Point, NC, USA
- Correspondence: Zoe Diana Draelos, Dermatology Consulting Services, PLLC, 2444 North Main Street, High Point, NC, 27262, USA, Tel +1-336-841-2040, Fax +1 336-841-2044, Email
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Ren J, Zhu Q, Wang S, Li X, Sun Z, Li N, Feng J, Ding H, Dong S, Wang H. Clinical efficacy and safety of using calcipotriol-betamethasone compounding agent for psoriasis treatment: a systematic review and meta-analysis. Arch Dermatol Res 2021; 314:633-641. [PMID: 34417633 DOI: 10.1007/s00403-021-02272-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/15/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022]
Abstract
The main objective is to evaluate clinical efficacy and safety of using calcipotriol-betamethasone compounding agent for psoriasis treatment through a systematic review and meta-analysis. We searched MEDLINE, Embase, The Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), and WanFang Data from inception till July 31, 2020. Efficacy was evaluated based on primary outcome indicators including skin lesion improvement and overall adverse reaction rate. Secondary outcome indicators included degree of life quality improvement, clinical effectiveness rate, and specific adverse reaction rates. RevMan5.3 was used to perform the meta-analysis. 22 studies finally met our inclusion criteria for the meta-analysis. The results indicated that for short-term treatment, a sequential therapy that uses calcipotriol betamethasone compounding agent and calcipotriol improves PASI score (MD = -0.94, 95% CI - 1.38 ~ - 0.49, P < 0.0001, I2 = 49%), comparing with using only calcipotriol. From a drug safety perspective, the difference in overall adverse reaction rate is not significant between the calcipotriol group and the sequential treatment group (RR = 0.50, 95% CI 0.22 ~ 1.14, P = 0.10, I2 = 33%). Calcipotriol betamethasone compounding agent may be more effective in plaque psoriasis treatment compared to use only calcipotriol, with no significant difference in adverse reaction rate between the two groups. Although the data were collected from 13 comparison groups, each group may not have sufficient data for a thorough and comprehensive analysis. Further research may be necessary for a more detailed evaluation of effectiveness of using calcipotriol betamethasone compounding agent for plaque psoriasis treatment.
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Affiliation(s)
- Junrong Ren
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Qi Zhu
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Siyao Wang
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaolong Li
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhen Sun
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Nan Li
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jian Feng
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Haining Ding
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Sitong Dong
- Systematic Review Solutions Ltd, The Ingenuity Centre, Triumph Road, Nottingham, NG7 2TU, UK
| | - Hongmei Wang
- Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China.
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Bark C, Brown C, Svangren P. Systematic literature review of long-term efficacy data for topical psoriasis treatments. J DERMATOL TREAT 2021; 33:2118-2128. [PMID: 33945378 DOI: 10.1080/09546634.2021.1925211] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify long-term efficacy evidence that supports use of topical therapies as regular maintenance therapy in the prevention of psoriasis relapse. METHODS A systematic literature review identified clinical trials and observational studies that reported efficacy outcomes for topical psoriasis therapies with treatment durations of at least 12 weeks. For therapies with long-term data, the approved treatment schedules in product labels were reviewed. RESULTS Forty-six studies with at least 12-week efficacy outcomes were identified. Eight randomized controlled trials and six observational studies or single-arm open-label studies reported efficacy data for >12-week treatment periods. Most studies used treatment regimens that reflect current standard of care of repeated treatment of relapses. The PSO-LONG study is the only identified randomized controlled trial to have compared regular proactive maintenance use of a topical treatment (calcipotriol/betamethasone foam) with reactive management in response to psoriasis relapses. CONCLUSIONS Limited high-quality long-term efficacy data are available for topical psoriasis therapies. While some product labels mention clinical experience of up to 12 months, they do not provide specific recommendations on the optimal long-term regimen. Calcipotriol/betamethasone foam is the only treatment for which the approved label allows either reactive treatment of relapse or regular (twice weekly) maintenance use.
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Affiliation(s)
| | | | - Per Svangren
- Svangren Life Science Consulting, Barseback, Sweden
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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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Mazzarello V, Piu G, Ferrari M, Piga G. Efficacy of a Topical Formulation of Sodium Bicarbonate in Mild to Moderate Stable Plaque Psoriasis: a Randomized, Blinded, Intrapatient, Controlled Study. Dermatol Ther (Heidelb) 2019; 9:497-503. [PMID: 31077089 PMCID: PMC6704198 DOI: 10.1007/s13555-019-0302-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Psoriasis is a chronic inflammatory disease characterized by the presence of erythematosquamous lesions. A wide variety of topical treatments for therapy of this pathology are available, including sodium bicarbonate (SB). A few papers reported in literature focus on use of SB baths for treatment of psoriasis, but none assess evidence concerning the efficacy of SB topical preparations. This study aimed to determine the effectiveness of a galenic SB in lanette vax formulation compared with lanette vax base in mild to moderate stable plaque psoriasis. METHODS A randomized, double-blind, intrapatient, controlled study was performed in 28 days. Thirty patients of both genders were selected for testing. A blinded investigator evaluated the patients' psoriasis using a modified Psoriasis Area and Severity Index (PASI), body surface area (BSA), and objective parameters using sensors (Multiprobe Adapter MPA5; Courage & Khazaka Electronic GmbH, Cologne, Germany). RESULTS Data analysis of objective parameters highlighted that use of the SB topical preparation led to no improvement in skin hydration, no reduction in transepidermal water loss, and no decrease of erythema. The modified PASI and BSA did not change from baseline. CONCLUSIONS The results obtained show that use of the studied product did not improve psoriatic lesions.
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Affiliation(s)
- Vittorio Mazzarello
- Skinlab, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Gabriella Piu
- Skinlab, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Marco Ferrari
- Skinlab, Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
| | - Giorgio Piga
- Skinlab, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Verallo-Rowell VM, Katalbas SS, Evangelista MTP, Dayrit JF. Review Update on Topical Therapy for Psoriasis. CURRENT DERMATOLOGY REPORTS 2018. [DOI: 10.1007/s13671-018-0209-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Abstract
Topical therapy as monotherapy is useful in psoriasis patients with mild disease. Topical agents are also used as adjuvant for moderate-to-severe disease who are being concurrently treated with either ultraviolet light or systemic medications. Emollients are useful adjuncts to the treatment of psoriasis. Use of older topical agents such as anthralin and coal tar has declined over the years. However, they are cheaper and can still be used for the treatment of difficult psoriasis refractory to conventional treatment. Salicylic acid can be used in combination with other topical therapies such as topical corticosteroids (TCS) and calcineurin inhibitors for the treatment of thick limited plaques to increase the absorption of the latter into the psoriatic plaques. Low- to mid-potent TCS are used in facial/flexural psoriasis and high potent over palmoplantar/thick psoriasis lesions. The addition of noncorticosteroid treatment can also facilitate the avoidance of long-term daily TCS. Tacrolimus and pimecrolimus can be used for the treatment of facial and intertriginous psoriasis. Tazarotene is indicated for stable plaque psoriasis usually in combination with other therapies such as TCS. Vitamin D analogs alone in combination with TCS are useful in stable plaques over limbs and palmoplantar psoriasis. Topical therapies for scalp psoriasis include TCS, Vitamin D analogs, salicylic acid, coal tar, and anthralin in various formulations such as solutions, foams, and shampoos. TCS, vitamin D analogs, and tazarotene can be used in the treatment of nail psoriasis.
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Affiliation(s)
- R. Torsekar
- Department of Dermatology, Rajiv Gandhi Medical College and Chhatrapati Shivaji Maharaj Hospital, Thane, Maharashtra, India
| | - Manjyot M. Gautam
- Dr. D.Y. Patil Medical College and Research Center, Navi Mumbai, Maharashtra, India
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Nast A. An Open Label Prospective Randomized Trial to Compare the Efficacy of Coal Tar-salicylic Acid Ointment Versus Calcipotriol/Betamethasone Dipropionate Ointment in the Treatment of Limited Chronic Plaque Psoriasis. Indian J Dermatol 2015; 60:198. [PMID: 25814714 PMCID: PMC4372918 DOI: 10.4103/0019-5154.152531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Alexander Nast
- Head of Guidelines Commission of European Dermatology Forum, Charité - Universitätsmedizin Berlin, 10117 Berlin, Germany. E-mail:
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Khandpur S, Sahni K. Authors' reply. Indian J Dermatol 2015; 60:198-9. [PMID: 25814715 PMCID: PMC4372919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Sujay Khandpur
- From the Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India. E-mail:
| | - Kanika Sahni
- From the Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India. E-mail:
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