Calcipotriol induces apoptosis in psoriatic keratinocytes

In recent years, vitamin D3 analogues have become one of the most widely prescribed topical treatments for mild or moderate chronic plaque psoriasis. These molecules are effective and safe, but their exact mechanism of action is not completely understood. In vitro studies have shown that D3 analogues decrease proliferation and induce differentiation of keratinocytes, and have strong immunomodulating effects, but there are no conclusive data about apoptosis. The aim of this study was to evaluate differences in apoptotic response between lesional and perilesional keratinocytes of patients with psoriasis before and after treatment with calcipotriol, a synthetic vitamin D3 analogue. Keratinocytes were isolated from psoriatic plaques including lesional and perilesional skin, and cultured. Cells were treated with calcipotriol for 20 h and examined under confocal microscopy after staining with propidium iodide. The number of apoptotic cells after incubation with calcipotriol was significantly higher in lesional than in perilesional keratinocytes (P < 0.05) or non‐treated psoriatic keratinocytes (P < 0.05). In conclusion, calcipotriol seems to induce apoptosis in psoriatic keratinocytes.     

Efficacy of calcipotriol ointment applied under hydrocolloid occlusion in psoriasis

BACKGROUND: Hydrocolloid (HCD) dressings enhance the efficacy of topical corticosteroids. OBJECTIVE: We wanted to evaluate the effect of calcipotriol ointment under an HCD dressing in the treatment of psoriatic plaques. METHODS: In 9 psoriatic patients, we cleared one plaque using this approach and took biopsies at start, clearance and relapse. Clinical and immunohistochemical validation was assessed. RESULTS: After an average treatment of 3.6 weeks, each lesion had cleared (apart from some residual erythema). The average remission period was 8 weeks. During this treatment, the number of cycling epidermal cells (Ki-67-positive nuclei) and the expression of keratin 14 and keratin 16 had decreased substantially. In biopsies taken from the skin immediately adjacent to the relapsing lesion, these markers remained reduced which indicated the prolonged effect of calcipotriol on epidermal differentiation. CONCLUSION: It is speculated that combination therapy of calcipotriol with treatments with a different mode of action such as photo(chemo)therapy, corticosteroids and cyclosporine might be worthwhile. Copyright (R) 2000 S.Karger AG, Basel     

Response of cutaneous microcirculation to treatment with mometasone furoate in patients with psoriasis

Background. In patients with psoriasis, videocapillaroscopy has been used to visualize the typical modifications in the microcirculatory architecture. Aim. To evaluate the modifications of the superficial capillary bed in a psoriatic plaque and healthy perilesional skin during treatment with a topical steroid. Methods. In total, 24 patients affected with psoriasis vulgaris were enrolled. Each patient was instructed to apply mometasone furoate cream 0.1% once daily to a selected psoriatic lesion for 12 weeks. At baseline (T0) and after 4 (T1), 8 (T2) and 12 (T3) weeks, clinical and capillaroscopic examination was made of the psoriatic plaque and the surrounding skin. Results. At the end of the study, the diameters of dilated and convoluted capillaries in the psoriatic plaque were significantly reduced (baseline, 69.2 μm; after 12 weeks, 29.3 μm; P < 0.0001) in all subjects. A marked clinical improvement was also noted (plaque score: baseline, 7.4; after 12 weeks, 0.5; P < 0.0001). The perilesional skin also showed improvement in capillaroscopic alterations, even if the drug had not been applied to those areas. Of the 24 patients, 12 were clinically healed at the end of the treatment period, although the capillaroscopic picture returned to normal in only 2 of them. Conclusions. Mometasone furoate cream proved to be effective in reducing the clinical and capillaroscopic alterations of the psoriatic plaque, but there was no association between clinical improvement and microcirculatory alterations noted. The action of mometasone furoate action on the microcirculation was not limited only to the area of application, but also extended to the surrounding areas.     

Calcipotriol plus short-contact dithranol: a novel topical combination therapy for chronic plaque psoriasis

The purpose of this double-blind randomised parallel-group study was to compare the efficacy and safety of short-contact treatment with dithranol ointment (2%) with its combination with calcipotriol ointment (50 microg/g) in 2 groups of in-patients with chronic plaque psoriasis. The patients of the first group (n = 23) topically applied dithranol once daily for 30 min and the vehicle of calcipotriol twice daily. The patients of the second group (n = 23) used a single topical application of dithranol for 30 min daily and additionally applied calcipotriol twice daily. The extent and the severity of psoriasis were assessed by means of psoriasis area and severity index score (PASI score) before the onset of the 6-week therapy and weekly thereafter. The difference between the two groups with regard to the mean PASI score became statistically significant already after the first week of treatment and remained so until the end of the trial. No significant differences were observed between the two groups with respect to the cutaneous adverse events. These findings indicate that the addition of calcipotriol ointment to short-contact dithranol markedly augments the therapeutic efficacy of the latter in chronic plaque psoriasis and impressively accelerates the response of psoriatic plaques to this well-tolerated regimen.     

The influence of psoriatic plaques pretreatment with crude coal tar vs. petrolatum on the efficacy of narrow-band ultraviolet B: a half-vs.-half intra-individual double-blinded comparative study

Background/purpose: The value of psoriatic plaques pretreatment with specific topical preparations in the setting of NB‐ultraviolet‐B (UVB) therapy is debatable. It may be clarified through a comparative assessment between crude coal tar and petrolatum as pretreatment candidates. Methods: A prospective study included 40 patients with plaque psoriasis undergoing NB‐UVB therapy. We compared among three treatment regimens: NB‐UVB alone (control group; n=20) as well as NB‐UVB preceded by crude coal tar 3% on one side and petrolatum on the other side (cases group I and II; n=20). Tar and petrolatum were topically applied thrice/day the day before NB‐UVB exposure. Applications were removed using olive oil directly before NB‐UVB exposure. Regimens' frequency was thrice/week and the clinical outcome was assessed, through both psoriasis area and severity index (PASI) and physician global assessment (PGA) scores, at baseline and 3 months later. Results: There were significant (P<0.01) decreases in both PASI and PGA scores in all the groups. In comparison with the controls, cases revealed significantly (P<0.05) higher improvement percentages in both PASI and PGA scores for both tar and petrolatum. This influence, through the PGA score, was significantly (P<0.05) in favor of petrolatum. Conclusion: The pretreatment of psoriatic plaques with either petrolatum or crude coal tar may enhance the therapeutic outcome of NB‐UVB, which appeared to favor petrolatum.     

Microcirculatory modifications of psoriatic lesions during topical therapy

Background/purpose: Videocapillaroscopy (VCP) can be used to explore microcirculatory modifications in skin diseases. Psoriasis presents a specifically altered capillaroscopic pattern with 'bushy' capillaries and a disarranged microangioarchitecture. The aim of the present study is to compare the clinical and capillaroscopic modifications of a psoriatic target lesion during topical therapy.
Methods: Thirty patients with chronic plaque psoriasis were included in the study. Clinical and capillaroscopic modifications in comparable lesions of the elbows were analyzed during different topical therapies (calcipotriol, betamethasone dipropionate and calcipotriol plus betamethasone dipropionate) at baseline, and after 15 and 30 days of therapy. A clinical global score (modified Psoriasis Area Severity Index), the mecapillary density per square mm and the mean diameter of capillary loops were measured.
Results: Topical therapy with combined betamethasone dipropionate and calcipotriol induced a higher decrease in erythema, infiltration and desquamation ( P <0.001), and a significant reduction of the mean 'bush' diameter ( P <0.001) and capillary number/mm² ( P <0.05) compared with betamethasone and calcipotriol alone. Microvascular restoration to a normal pattern, as detected by VCP, was faster than clinical improvement ( P <0.05).
Conclusion: Videocapillaroscopy is an easily executable and non-invasive technique that detects early microcirculatory changes in psoriasis during topical therapy.     

皮肤镜观察外用药物治疗寻常性银屑病的效果及分析

目的皮肤镜动态观察寻常性银屑病外用卤米松乳膏、卡泊三醇软膏和卤米松乳膏/卡泊三醇软膏治疗后的疗效,及皮损血管的改变和临床评分mPASI的相关性。方法选择2018年6月-2018年9月在本院就诊的30例寻常性银屑病患者,随机分为2组,一组给予卤米松乳膏外用,另一组给予卡泊三醇软膏外用,30例患者的一侧上肢皮损给予卤米松乳膏/卡泊三醇软膏外用。患者于治疗0、2、4及6周使用皮肤镜观察皮损处血管的变化,同时对观察皮损做mPASI评分并记录,比较3种治疗方法的皮损mPASI评分与血管指标的差异及治疗后mPASI评分与血管直径随时间的关系。结果卤米松乳膏/卡泊三醇软膏的局部治疗皮损临床评分和皮肤镜血管变化(血管直径及血管密度)与单独外用卤米松乳膏、卡泊三醇软膏的恢复更明显。银屑病皮损临床评分mPASI与血管球直径随时间的变化趋势一致。结论卤米松乳膏/卡泊三醇软膏局部外用治疗寻常性银屑病的效果优于单独应用;皮肤镜在银屑病皮损恢复情况及临床药物疗效的观察中具有临床价值。     

Double-blind, placebo-controlled, randomized, right-left study comparing calcipotriol monotherapy with a combined treatment of calcipotriol and diflucortolone valerate in chronic plaque psoriasis

A double-blind, randomized clinical study was conducted to compare the efficacy and tolerability of twice-daily topical calcipotriol treatment with a combination treatment of calcipotriol once a day in the morning and diflucortolone valerate in the evening. Sixty-three patients with a clinical diagnosis of chronic plaque psoriasis and comparable psoriatic lesions on both sides of the body were included. After a washout phase of 1 week, psoriatic lesions were treated for 4 weeks with calcipotriol ointment twice daily on one side of the body and a combination of calcipotriol and diflucortolone valerate ointment on the other side. The treatment period was followed by a period of 4 weeks without any treatment. The psoriasis area and severity index (PASI) was used to compare the 2 groups. Furthermore, the overall therapeutic results were assessed independently by the investigators and by the patients. Both treatment regimens showed a significant, nearly identical, reduction in PASI. The mean PASI for calcipotriol alone was 5.7 at baseline, 1.9 after 4 weeks of treatment and 3.8 at the end of the follow-up period. For combination therapy, these values were 5.7, 1.8 and 3.8, respectively. There was a statistically significant advantage in favor of combined calcipotriol and diflucortolone valerate treatment at weeks 1 and 2 (p < 0.05); however, at the end of the treatment phase the difference between the 2 therapies was not significant. Subjective evaluation of efficacy by both the investigators and the patients revealed no difference between the 2 treatments. The frequency of side effects (e.g. irritation) was low in both groups. In conclusion, both therapies were effective for the treatment of chronic plaque-type psoriatic lesions. The combination of calcipotriol and a topical steroid appeared to produce a more rapid clinical response and was shown to be as effective as calcipotriol therapy alone.     

Occlusion enhances the efficacy of topical calcipotriol in the treatment of psoriasis vulgaris

Forty-eight patients with symmetrical chronic plaque psoriasis affecting the limbs were recruited for a single-blind right/left within patient study to assess the effect of combining occlusion with topical calcipotriol. Subjects were randomized into two groups. Sites of similar severity on opposing limbs were selected as target areas. The first (group A) treated one side with calcipotriol alone and the opposite side with calcipotriol plus occlusion. The second (group 13) treated one side with placebo plus occlusion and the opposite side with calcipotriol plus occlusion. In group A the mean improvements were 40% (P< 0·001) for calcipotriol alone and 61% (P< 0·001) for calcipotriol plus occlusion. In group B, occlusion plus calcipotriol resulted in a mean 62% improvement (P< 0·001) while occlusion plus placebo produced no significant change. The combination of calcipotriol plus occlusion was significantly better than calcipotriol alone (P< 0·005). The results indicate that occlusion improves the response to calcipotriol by enhancing its penetration. Indices of calcium metabolsm remained unchanged throughout the study.     

A comparative study on the use of fractional CO2 laser with tacrolimus or calcipotriol or narrow band ultraviolet‐B in treatment of stable nonsegmental vitiligo

Conventional methods of treatment for vitiligo are often unsatisfactory to the patients and time consuming, new treatment modalities are needed. This study was conducted to evaluate the efficacy and safety of fractional carbon dioxide (CO₂) laser therapy followed by narrow band ultraviolet‐B (NB‐UVB) phototherapy, topical tacrolimus or topical calcipotriol on stable nonsegmental vitiligo. Thirty patients with stable nonsegmental vitiligo were evaluated. All patients were subjected to three sessions of fractional CO₂ laser 1 month apart. Patients were divided into three groups (each group 10 patients). Group (A) treated with tacrolimus ointment twice daily for 3 months, group (B) treated with calcipotriol ointment twice daily for 3 months, and group (C) treated with NB‐UVB twice weekly for 3 months. Outcomes were evaluated by calculating vitiligo area scoring index (VASI) score change, percentage of repigmentation, patient satisfaction, and adverse effects. There was a statistical significant decrease in VASI score after treatment in the three groups. The VASI change and % of regimentation was higher in group (C) treated by laser and NB‐UVB and this was significantly higher than group (B) treated with laser and calcipotriol. Otherwise, there was no statistical significant difference between other treatment groups. In concluion, NB‐UVB phototherapy, topical tacrolimus, or topical calcipotriol in combination with fractional CO₂ laser could be used effectively and safely as an alternative modality for treatment of vitiligo. The combination of fractional CO₂ laser and NB‐UVB was found to be more effective.     

Topical tazarotene vs. coal tar in stable plaque psoriasis

Background. The efficacy of topical tazarotene has not previously been compared with the conventional topical treatment of crude coal tar (CCT) in stable plaque psoriasis. Aim. To assess the comparative efficacy and tolerability of topical tazarotene 0.1% gel and CCT 5% ointment in stable plaque psoriasis. Methods. In this nonblinded side‐to‐side comparison study, patients with chronic stable plaque psoriasis, who had bilaterally symmetrical plaques on the limbs, applied 0.1% tazarotene gel on the right side and 5% CCT ointment on the left side once daily for 12 weeks followed by an 8‐week treatment‐free follow up period. Severity of psoriatic lesions and response to treatment was evaluated by scoring erythema, scaling and induration (ESI). Results. Of 30 patients recruited, 27 could be assessed. In the per‐protocol analysis, the mean percentage reduction in ESI score at the end of the treatment period was 74.15% ± 9.43 and 77.37% ± 10.93 with tazarotene and CCT, respectively (P > 0.05). A reduction in ESI score of > 75% was seen in 11 (40.74%) and 16 (59.26%) patients with tazarotene and CCT, respectively, at the end of 12 weeks. Side‐effects were seen in 48.14% of patients treated with tazarotene, but in no patient treated with CCT. Conclusions. Tazarotene 0.1% gel has comparable clinical efficacy to CCT 5% ointment. CCT ointment remains a cost‐effective therapy for plaque psoriasis.     

Clobetasol propionate followed by calcipotriol is superior to calcipotriol alone in topical treatment of psoriasis

Background Although potent, topical corticosteroids offer effective and rapid healing of psoriatic lesions. Their long term use is limited because of the risk of side effects. Calcipotriol is safe for long-term treatment, but its initial efficacy is lower than with topical corticosteroids.
Objectives To investigate whether 2 weeks of treatment with clobetasol propionate 0.05% ointment bd followed by 4 weeks of treatment with calcipotriol 50 /μg/g bd would offer therapeutic advantages over 6 weeks of continuous treatment with calcipotriol.
Methods Forty-nine patients with moderate to severe plaque psoriasis were recruited from five centres in Norway. In a randomised, double-blind, right- versus left-side comparison, ointments were applied to two symmetrically-located areas.
Results Two weeks of treatment with clobetasol propionate produced a significantly greater decrease in total symptom score (combined scores of erythema, induration and scaling) than calcipotriol treatment ( P < 0.0001). This improvement on the clobetasol.propionate-treated side of the body was maintained throughout a subsequent 4-week treatment period when calcipotriol was applied to both sides of the body ( P < 0.0001). The superiority of the clobetasol propionate followed by calcipotriol treatment was maintained during a 4-week, treatment-free, observation period. Treatments were well tolerated with no rebound effect.
Conclusions Clobetasol propionate ointment bd for 2 weeks followed by treatment with calcipotriol ointment bd for 4 weeks was superior to calcipotriol ointment alone in the treatment of plaque psoriasis.     

Evaluation of the Vascular Pattern in Psoriatic Plaques in Children Using Videodermatoscopy: An Open Comparative Study

Psoriasis is a common erythematous desquamative dermatosis. The diagnosis may sometimes be troublesome in children, especially if clinical presentation is mild or atypical. Videodermatoscopy has been suggested as a new noninvasive aid for the diagnosis of psoriasis, prognostic evaluation, and treatment monitoring. An open comparative study in children aimed at assessing the correlation between the vascular pattern evaluated using videodermatoscopy and the clinical diagnosis of psoriasis and other erythematous desquamative disorders was designed and performed. Sixty Caucasian children were enrolled and subdivided into two groups: group A, 24 patients with multiple plaque psoriasis; group B, 36 patients with other erythematous desquamative disorders. At least two lesions were examined in each patient using videodermatoscopy at 150× magnification and the superficial vascular pattern of each lesion was evaluated in three different fields. In group A, the presence of dilated capillaries with a “bushy” aspect, homogeneously distributed in all examined fields, was seen in all considered plaques. In group B, videodermatoscopic findings were not specific, showing normal‐looking capillaries, slightly dilated vessels, or a few isolated “bushes.” Videodermatoscopy may be considered an important adjunct diagnostic tool in clinically doubtful erythematous desquamative lesions in children, allowing a psoriatic vascular pattern to be confirmed or excluded, with some distinct advantages over skin biopsy.     

The effects of UVB plus calcipotriol on systemic calcium homeostasis in patients with chronic plaque psoriasis

We studied the effects of combining topical calcipotriol, used at the maximal licensed dose, and narrow-band short wave ultraviolet light (TL01) on systemic calcium homeostasis in the treatment of chronic plaque psoriasis. Patients were randomized in an open fashion to receive either UVB alone, UVB plus 100 g of calcipotriol (50 μg/g) ointment per week or calcipotriol ointment alone (100 g/week). With the exception of a slight increase in serum phosphate in the group receiving combination therapy (from 0·92 to 1·22 mmol/l; P= 0·046), no differences were observed between or within the groups. Psoriasis area and severity scores (PASI) improved to a greater extent in those patients receiving both UVB and calcipotriol (P= 0·045). The combination of UVB and calcipotriol is a safe, effective treatment for chronic plaque psoriasis.     

Apoptosis, P53 and Bcl-2 expression in response to topical calcipotriol therapy for psoriasis

BACKGROUND: The histopathologic changes characteristic of psoriasis might be related to suppressed apoptosis. The P53 and Bcl-2 proteins play a central role in the regulation of apoptosis. This study aimed to evaluate P53 and Bcl-2 expression and apoptotic cells in the psoriatic skin before and after topical calcipotriol therapy. METHODS: Skin biopsies were obtained from nonlesional and lesional skin of 10 patients with generalized plaque psoriasis before and after treatment with topical calcipotriol ointment. The P53 and Bcl-2 expression was evaluated using immunoperoxidase technique and apoptotic cells by the terminal deoxynucleotide transferase (TdT) mediated deoxyuridine triphosphate nick end labeling (TUNEL) method. RESULTS: After topical calcipotriol therapy, keratinocytes of psoriatic skin showed significant decrease of P53 (P = 0.002) and increase of Bcl-2 (P = 0.01) expression. On the other hand lymphocytes showed significant decrease of Bcl-2 (P = 0.01). There were no apoptotic cells before treatment but after calcipotriol therapy, apoptosis was more detectable in keratinocytes than in lymphocytes. CONCLUSIONS: The results of the study suggested that one of the actions of calcipotriol in psoriasis might be exerted through induction of apoptosis, especially of keratinocytes, through a P53-independent pathway. Meanwhile, suppression of Bcl-2 expression in lymphocytes may promote apoptosis of dermal lymphocytes leading to healing of psoriasis.     

Comparison of clinical effects of psoriasis treatment regimens among calcipotriol alone,narrowband ultraviolet B phototherapy alone,combination of calcipotriol and narrowband ultraviolet B phototherapy once a week,and combination of calcipotriol and narrowband ultraviolet B phototherapy more than twice a week

We compared the clinical efficacy of various psoriasis treatments among: (i) topical application of calcipotriol ointment twice daily (group I); (ii) topical application of calcipotriol ointment twice daily and narrowband ultraviolet B NB‐UVB phototherapy once a week (group II); (iii) topical application of heparinoid ointment twice daily and NB‐UVB phototherapy more than twice a week (group III); and (iv) topical application of calcipotriol ointment twice daily and NB‐UVB phototherapy more than twice a week (group IV). Ten patients were randomly selected for each group and treated by the indicated regimens for 12 weeks. All treatments were effective and significantly improved Psoriasis Area and Severity Index (PASI) scores, self‐administered PASI scores and visual analog scale scores of pruritus. Group IV showed most marked and rapid reduction in PASI and self‐PASI scores among the four regimens. Although the serum levels of interleukin (IL)‐17, IL‐20 and IL‐22 and psoriasis disability index were significantly decreased after the treatments, no significant difference was detected among the four groups. Our study indicates that combination of calcipotriol ointment plus NB‐UVB more than twice a week is superior to other treatment regimens, rapidly improving psoriasis lesions.     

Effect of topical vitamin D on chronic kidney disease‐associated pruritus: An open‐label pilot study

Chronic kidney disease‐associated pruritus (CKD‐aP) is a troublesome symptom in patients with end‐stage renal disease (ESRD). Recently, vitamin D deficiency has been known to be one of the possible etiologic factors in CKD‐aP. However, limited data is available on whether topical vitamin D treatment is effective for relieving CKD‐aP. Therefore, the purpose of this study is to evaluate the effectiveness of topically vitamin D for CKD‐aP. Twenty‐three patients with CKD‐aP were enrolled in a single center, open‐label study. Patients were instructed to apply a topical vitamin D (calcipotriol) agent (Daivonex solution; LEO Pharma) or vehicle solution twice daily for a month. We assessed the efficacy and safety of topical vitamin D on CKD‐aP using clinical and dermoscopic photographs, and questionnaires including the validated modified pruritus assessment score (VMPAS) and visual analog scale (VAS) every 2 weeks. Dry dermoscopic findings showed significant improvement of scale (dryness) on the skin of topical vitamin D‐treated patients compared with those of the vehicle group. Both VMPAS and VAS were significantly decreased after 2 and 4 weeks of the topical vitamin D treatment compared with the vehicle, respectively (P < 0.05). No significant side‐effects were observed. Topical vitamin D may be one of the safe and effective therapeutic candidates for CKD‐aP.     

Ausgeprägte Hyperpigmentierung in psoriatischen Plaques als Folge einer Kombinationsbehandlung mit UVB-311 nm und Calcipotriol

The combination of UVB phototherapy with topical application of vitamin D analogs is frequently used for treating psoriasis. This regimen is not only very effective but also has only minimal side effects. Pronounced, persistent hyperpigmentation developed in the psoriatic plaques in a patient who was treated with combined UVB (311 nm) radiation and topical calcipotriol.     

Topical calcipotriol plus oral fumaric acid is more effective and faster acting than oral fumaric acid monotherapy in the treatment of severe chronic plaque psoriasis vulgaris

BACKGROUND: Calcipotriol is an established topical therapy for psoriasis vulgaris. OBJECTIVE: This study aimed to investigate whether the addition of calcipotriol to fumaric acid ester (FAE) monotherapy had an additive efficacy and an FAE-sparing effect in patients with severe plaque psoriasis. METHODS: This multicentre, randomised, double-blind, vehicle-controlled study included 143 patients for up to 13 weeks treatment. Group A received FAE tablets (Fumaderm) with an increasing daily dosage from 105 to 1,075 mg + ointment vehicle. Group B received FAE tablets + calcipotriol ointment (50 microg/g). Ointments were applied twice daily. Clinical response was assessed using percentage changes in the Psoriasis Area and Severity Index (PASI), from baseline to treatment end. RESULTS: The mean percentage change in the PASI was -76.1% in group B and -51.9% in group A, the difference between treatments was -24.2% (95% CI from -34.2 to -14.2%; p < 0.001). Group B responded more rapidly to treatment. Investigators' and patients' overall efficacy assessments were significantly more favourable for group B (p < or = 0.001). Group B was prescribed less FAE than group A. This difference was greatest at the last visit (mean daily dose 529 and 685 mg, respectively; p = 0.006). Overall adverse events in the two groups were similar. CONCLUSION: This study shows that the combination of calcipotriol and FAEs is significantly more effective and faster acting than FAE monotherapy in the treatment of severe plaque psoriasis. The combination has a slight FEA-sparing effect and therefore a superior benefit/risk ratio.     

Efficacy of the pulsed dye laser in the treatment of localized recalcitrant plaque psoriasis: a comparative study

BACKGROUND: Localized chronic plaque psoriasis, resistant to local therapy, may be very hard to treat. The treatment of these lesions with a pulsed dye laser (PDL) has been described before, but a comparative study between the PDL and a potent topical treatment has never been performed. OBJECTIVES: To compare the efficacy of the PDL in the treatment of localized, recalcitrant plaque psoriasis with a potent topical therapy, using calcipotriol/betamethasone dipropionate (Dovobet) as an active comparator. METHODS: Eight patients with psoriasis were treated with both PDL (585 nm) and calcipotriol/betamethasone dipropionate in an open, intrapatient, left-right comparison. A plaque severity score (sum score) and photographs were used to document the course of therapy. Patients reported pain on a visual analogue scale. RESULTS: Both treatments were well tolerated, although one patient left the study due to post-PDL treatment pain. A significant difference in the sum score 12 weeks after treatment was seen in favour of the PDL (62% vs. 19% reduction; P<0.05). Scores for erythema declined significantly at week 12 in both the PDL and the calcipotriol/betamethasone dipropionate group (P<0.001). Induration and desquamation scores were significantly reduced at week 12 in the PDL group, without a statistically significant reduction in calcipotriol/betamethasone-treated lesions. The pain scores declined with progressive PDL treatments, although not statistically significantly. CONCLUSIONS: PDL treatment might be considered for the treatment of localized, recalcitrant plaque psoriasis, when other topical therapies have failed.