外用他克莫司与卡泊三醇治疗斑块状银屑病的疗效与安全性评价

目的:评价外用他克莫司和卡泊三醇软膏对四肢斑块状银屑病的疗效和安全性.方法:选取门诊斑块状银屑病患者,四肢左右两侧分别外用他克莫司软膏及卡泊三醇软膏,治疗2周及6周各复诊1次,观察四肢左右侧皮损消退情况,用单侧银屑病皮损面积及严重度指数(PASI)评分进行评价.结果:29例患者参加自身左右侧药物对比,有3例患者(10.3％)应用他克莫司后出现皮肤刺激症状而停用,其中1例患儿出现红皮病样改变.2周时有13例患者复诊,达到PASI50的患者中他克莫司侧4例,卡泊三醇侧5例;达到PASI75的患者中他克莫司侧1例,卡泊三醇侧2例.6周时14例患者复诊,达到PASI50的患者中他克莫司侧14例,卡泊三醇侧13例;达到PASI75的患者中他克莫司侧7例,卡泊三醇侧9例.2周及6周时比较双侧PASI50及PASI75,用Fisher精确概率检验法,发现两者差异无统计学意义.结论:对于四肢的斑块状银屑病,外用他克莫司和卡泊三醇软膏均有肯定疗效.部分患者应用他克莫司出现皮肤刺激症状,停药后症状多可消退.     

No additional effect of calcipotriol ointment on low-dose narrow-band UVB phototherapy in psoriasis

BACKGROUND: Broad-band UVB phototherapy has appeared to be effective in clearing psoriatic lesions. After the advent of calcipotriol ointment, promising results have been obtained by combining these two therapeutic modalities. Also, an additional effect of narrow-band UVB phototherapy on treatment with calcipotriol ointment has been demonstrated. OBJECTIVE: Our purpose was to compare treatment with low-dose narrow-band UVB phototherapy both with and without calcipotriol ointment. METHODS: We included 53 patients suffering from plaque-type psoriasis. All patients underwent low-dose narrow-band UVB phototherapy. Nearly half of the patients were randomized to apply calcipotriol ointment (50 microg/g) twice daily on the affected skin. The Psoriasis Area and Severity Index (PASI) was used to evaluate psoriatic lesions. RESULTS: In this study we showed that low-dose narrow-band UVB phototherapy is effective in the treatment of psoriasis and that calcipotriol ointment does not improve treatment outcome. CONCLUSION: Calcipotriol ointment does not improve treatment with low-dose narrow-band UVB phototherapy.     

Combined treatment of psoriasis with acitretin and UVB phototherapy compared with acitretin alone and UVB alone

The administration of UVB phototherapy and low-dose acitretin (0.34-0.44 mg/kg body weight) was compared with the effect of acitretin alone and UVB phototherapy alone in 41 patients with plaque-type psoriasis. Of these patients, 32 received standard UVB phototherapy without acitretin. The other nine were treated with acitretin and the effect of UVB irradiation (Sylvania UV 21-tubes), applied to one half of the body, was assessed. Clearance was defined as 80-100% improvement and this occurred in eight out of the nine patients (89%) treated with acitretin-UVB (ReUVB) and, in two of them (23%), on the untreated side. Clearance occurred in 20 of the 32 (62.5%) patients given UVB alone. The improvement score was significantly higher for the ReUVB side than the acitretin side. Patients treated with ReUVB showed a statistically higher therapeutic score (95-100% clearance) than those receiving UVB alone. However, taking 80-100% improvement as the criterion, no significant difference was found. The number of treatments to clearance was significantly less for the patients treated with ReUVB than for the UVB (19.3 as compared with 24.9). The total UVB dose and the number of minimal erythema doses (MEDs) could be reduced by approximately 20% in the ReUVB group relative to the UVB group.     

Comparison of the efficacy of broad‐band targeted UVB phototherapy and topical psoralen with targeted UVA phototherapy in localized vitiligo

Aim of the study is to compare efficacy of targeted broad‐band UVB phototherapy and topical psoralen with targeted UVA phototherapy treatments in localized vitiligo for 3 months prospectively. The cases with symmetrical vitiligo lesions were included in the study. Broad‐band targeted UVB was applied on one side and targeted UVA phototherapy with topical psoralen on the other side. Twenty‐two patients who were diagnosed with localized vitiligo were enrolled in this study. These cases consisted of 6 (27.3%) females and 16 (72.7%) males aging between 17 and 69 (34.22 ± 14.15). Fifty‐four lesions (27 left, 27 right) were compared for treatments. After the first month of the treatments, the sides of the lesions were compared in order to evaluate improvement. Percentages of success were 25% for targeted broad‐band UVB microphototherapy and 75% for topical psoralen with targeted UVA microphototherapy. When the two treatment methods were compared with each other, a significant difference was found in terms of treatment response (P = .017). At the end of the third month, the success rates were 37.5% for targeted broad‐band UVB microphototherapy and 62.5% for topical psoralen with targeted UVA microphototherapy, however a statistically significant difference was not determined between the two treatments (P > .05). Both targeted broad‐band UVB phototherapy and topical psoralen with targeted UVA phototherapy provided repigmentation for localized vitiligo at the end of the third month. Our investigation shows that both treatments are safe and they provide repigmentation with a limited response.     

Efficacy of once-daily treatment regimens with calcipotriol/betamethasone dipropionate ointment and calcipotriol ointment in psoriasis vulgaris

BACKGROUND: A two-compound ointment containing calcipotriol 50 micro g g-1 and betamethasone dipropionate 0.5 mg g-1 has recently been shown to be an effective treatment for psoriasis. OBJECTIVES: This study was designed to investigate efficacy and safety of different treatment regimens with the two-compound product (Daivobet/Dovobet; LEO Pharma, Ballerup, Denmark) and calcipotriol 50 micro g g-1 ointment (Daivonex/Dovonex; LEO Pharma). METHODS: In total, 972 patients with psoriasis vulgaris were randomized to one of three treatment regimens: group 1, the two-compound product once daily for 8 weeks followed by calcipotriol ointment once daily for 4 weeks; group 2, the two-compound product once daily for 4 weeks followed by 8 weeks of treatment with calcipotriol ointment once daily on weekdays and the two-compound product once daily at weekends; and group 3, calcipotriol ointment twice daily for 12 weeks. The efficacy was evaluated by Psoriasis Area and Severity Index (PASI) and investigators' global assessments of disease severity. The primary response criteria were percentage reduction in PASI and proportion of patients with absent/very mild disease according to the investigators' global assessments after 8 weeks of treatment. RESULTS: The mean reduction in PASI from baseline to the end of 8 weeks of treatment was 73.3% for group 1, 68.2% for group 2 and 64.1% for group 3. The proportion of patients with absent/very mild disease at the end of 8 weeks of treatment was 55.3% for group 1, 47.7% for group 2 and 40.7% for group 3. For both primary response criteria, group 1 was statistically superior to group 3 (P < 0.001), whereas group 2 did not differ significantly from group 3. The difference between group 1 and group 2 was statistically significant with regard to PASI but not regarding the proportion of patients with absent/very mild disease. Patients receiving initial therapy with the two-compound product achieved the fastest treatment response, and the maximum treatment effect for these patients was seen after 5 weeks. This effect was maintained with continued treatment with the two-compound product for up to 8 weeks. After 12 weeks of treatment, no significant differences were seen between the three groups with regard to reduction in PASI, whereas the proportion of patients with absent/very mild disease in group 2 was superior to that in group 3. Patients receiving therapy with the two-compound product experienced fewer lesional/perilesional adverse drug reactions than the calcipotriol-treated patients (P < 0.001): 10.9% in group 1, 11.5% in group 2 and 22.3% in group 3. CONCLUSIONS: Two different short-term treatment regimens employing a recently developed two-compound product (calcipotriol/betamethasone dipropionate) provided rapid and marked clinical efficacy and were shown to be safe therapies for psoriasis vulgaris.     

Tazarotene gel with narrow-band UVB phototherapy: a synergistic combination in psoriasis

Background: Narrow-band UVB (NB-UVB) has been shown to be one of the most effective treatment modalities for psoriasis. Tazarotene, a known effective anti-psoriatic modality, when combined with NB-UVB may enhance the therapeutic success.Objective: To study clinical efficacy and safety of combination of NB-UVB with topical tazarotene 0.05% gel in psoriasis.Method: Thirty patients with plaque psoriasis having symmetrical lesions were enrolled for 12 weeks. All patients were instructed to apply tazarotene gel on target plaque on left side of body once daily. In addition, the whole body was irradiated with NB-UVB twice weekly. Efficacy was assessed by target plaque scoring and number of treatment sessions for clearance.Result: Our study resulted in 3 key findings: Firstly, therapeutic efficacy of NB-UVB was enhanced by addition of tazarotene. This enhanced efficacy was more apparent in decreasing scaling and thickness as compared to decrease in erythema. Secondly, combination therapy showed faster clearance of target plaques, with reduction in mean number of treatment sessions. Thirdly, mean cumulative NB-UVB dose needed to achieve clearance of target plaques was significantly reduced with combination therapy.Study limitations: The study was not randomized or controlled, but an open-label trial. The study period was relatively short, i.e., 12 weeks, without any follow-up period.Conclusion: Tazarotene gel significantly enhances the therapeutic efficacy of NB-UVB irradiation with faster clearance and without serious side effects.     

【开放获取】丙酸氟替卡松乳膏单独或联合卡泊三醇软膏治疗轻中度斑块状银屑病的随机自身对照研究

【摘要】 目的 评价0.05%丙酸氟替卡松乳膏单独应用及与0.005%卡泊三醇软膏联合应用治疗轻中度斑块状银屑病的短期疗效和安全性。方法 2020年10月至2021年1月,于北京友谊医院对30例轻中度斑块状银屑病患者采用随机、开放、自身对照临床研究,一侧肢体皮损处早上外用0.005%卡泊三醇软膏、晚上外用0.05%丙酸氟替卡松乳膏（联合用药组）,对侧肢体皮损处每日外用2次0.05%丙酸氟替卡松乳膏（丙酸氟替卡松组）,疗程4周。分别于治疗前、治疗1、2、4周随访,采集静态临床医生整体评估（sPGA）、银屑病面积和严重程度指数（PASI）等临床指标,并记录不良事件。采用重复测量的方差分析、多变量方差分析、Mann-Whitney U秩和检验和独立样本t检验进行疗效和安全性评价。结果 治疗前,两组sPGA评分、PASI评分差异均无统计学意义（均P > 0.05）。治疗1周,丙酸氟替卡松组sPGA（1.10 ± 0.31）分、PASI评分（1.05 ± 0.51）分显著低于联合用药组［sPGA（1.73 ± 0.45）分,PASI评分（1.38 ± 0.69）分,F = 40.74、4.38,均P < 0.05］;治疗2、4周,联合用药组sPGA为（0.83 ± 0.46）、（0.23 ± 0.43）分,PASI评分为（0.53 ± 0.47）、（0.23 ± 0.50）分,均显著低于丙酸氟替卡松组（F = 4.88、56.14、15.21、26.36,均P < 0.05）。治疗1周,丙酸氟替卡松组浸润/肥厚严重程度评分显著低于联合用药组（U = 165.00,P < 0.05）;治疗2、4周,联合用药组红斑、鳞屑严重程度评分均显著低于丙酸氟替卡松组（U = 540.00、765.00、825.00、795.00,均P < 0.05）。结论 单用0.05%丙酸氟替卡松乳膏治疗银屑病起效快,0.05%丙酸氟替卡松乳膏与0.005%卡泊三醇软膏联合用药治疗2、4周效果更好,两种方法安全性均可。     

Ultraviolet phototherapy in psoriasis with hydrophilic ointment alone or with crude coal tar

Summary Plaques of 12 psoriatic patients treated with crude coal tar and ultraviolet irradiation were compared with symmetric areas treated with the same ultraviolet light (UVL) source and a hydrophilic ointment vehicle. Of the 12 patients, 10 received 75–100% clearing at both sites regardless whether the tar or the vehicle was applied. Treatment three times weekly was as effective as five times weekly. It was uncertain if the addition of UV-A irradiation to the UVL system in a small group using tar had a more beneficial effect.     

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.     

钙泊三醇倍他米松软膏联合卡泊三醇软膏序贯治疗寻常型银屑病疗效评价

目的：评价钙泊三醇倍他米松软膏联合卡泊三醇软膏治疗寻常型银屑病的临床疗效。方法：30例银屑病患者全身左右侧皮损随机分为治疗组或对照组。治疗组外用钙泊三醇倍他米松软膏和卡泊三醇软膏;对照组外用卡泊三醇软膏。治疗第2、4、8周末进行疗效评价。结果：治疗2、4、8周后治疗组有效率（53.33%、70%和86.67%）均明显高于对照组（30%、46.67%和66.67%）,组间差异均有统计学意义（P〈0.05）。结论：钙泊三醇倍他米松软膏联合卡泊三醇软膏治疗寻常型银屑病疗效较单独使用卡泊三醇好。     

Calcipotriol (Dovobet) ointment in combination with UVB therapy for psoriasis treatment

Dovobet is a compounded combination of calcipotriol [also calcipotriene] and betamethasone diproprionate, and is used for psoriasis vulgaris once daily. For this photo case presentation, Dovobet was used once daily in combination with UVB phototherapy 3 times a week. Light therapy was increased by 10% increments at each visit or as tolerated by the patient. Results show the combination of light therapy plus Dovobet may be an effective and convenient option in the treatment of psoriasis.     

Efficacy of a far erythemogenic dose of narrow-band ultraviolet B phototherapy in chronic plaque-type psoriasis

The aim of the present study was to examine the effect of far erythemogenic dose of narrow-band ultraviolet B (NB-UVB; starting dose at 35% minimal erythematous dose [MED]) on clinical response by measuring the severity, extent of disease and the changes in quality of life. Fifty patients with chronic plaque-type psoriasis were enrolled. Therapy was held for 3 days a week. The severity of the disease was assessed based on the Psoriasis Area and Severity Index (PASI) score and Dermatology Life Quality Index (DLQI) scores. The percentage improvement of PASI at 30 sessions was 68.99%. The improvement in DLQI scores at 30 sessions was 79.67%. Pearson correlation coefficients showed that PASI scores were not correlated with DLQI scores at the beginning of treatment ( P  = 0.330, r  = 0.14), but after the 30th session of NB-UVB therapy improvements in quality of life were correlated ( P  < 0.05, r  = 0.399). Therefore, far erythemogenic dose of NB-UVB is considered to be effective treatment for plaque-type psoriasis in our patients. However, we cannot confirm that it is safer than higher MED starting dose in term of cumulative UV irradiation.     

Combination phototherapy of psoriasis with narrow-band UVB irradiation and topical tazarotene gel

BACKGROUND: Narrow-band UVB (311 nm) phototherapy offering an emission spectrum closely conforming to the peak of the action spectrum for clearing psoriasis has significantly improved phototherapy for psoriasis. Because the majority of the commonly used topical therapies in treatment of psoriasis have limitations, a need for new topical agents remains. Tazarotene has been shown to be efficacious in plaque-type psoriasis. Combination of narrow-band UVB with topical agents has been shown to enhance efficacy of both treatment modalities. OBJECTIVE: We attempted to evaluate the efficacy of narrow-band UVB phototherapy in combination with topical tazarotene. METHODS: Ten patients with stable plaque psoriasis were treated with narrow-band UVB. In addition, topical tazarotene 0.05% was applied once daily to one side of the body. The follow-up period was 4 weeks. Efficacy was assessed separately for both body halves by means of a modified Psoriasis Area and Severity Index (PASI). RESULTS: Both treatment modalities notably reduced the PASI scores with values being significantly lower in skin areas treated with narrow-band UVB phototherapy in combination with topical tazarotene. CONCLUSION: The addition of tazarotene to narrow-band UVB phototherapy promotes more effective, faster clearing of psoriasis compared with UVB (311 nm) monotherapy.     

他扎罗汀凝胶外用联合NB-UVB治疗斑块状寻常型银屑病的疗效观察

目的：观察他扎罗汀凝胶外用联合NB-UVB照射治疗斑块状寻常型银屑病的疗效及安全性。方法：对35例轻、中度患者采用0．05％他扎罗汀凝胶每晚1次外涂配合NB-UVB每周2次照射，共治疗8周，用PASI积分评价疗效。结果：治疗开始1～2周后出现疗效，随着治疗时间的延长。有效率逐渐提高，治疗结束时痊愈率达到94．29％，有效率达100％。6例发生皮肤刺激反应，占17．14％。结论：他扎罗汀凝胶外用联合NB-UVB照射治疗斑块状寻常型银屑病具有良好疗效和安全性。     

The effect on psoriasis of clobetasol propionate used alone or in combination with UVB

A study has been carried out to compare the effect of a combination of clobetasol propionate and UVB versus placebo/UVB. No significant reduction in time to healing was observed. However, symptoms abated more rapidly in the steroid/UVB group. Recurrences occurred at an earlier stage following the steroid UVB combination for long periods. A third group, treated solely with clobetasol propionate has also been investigated, but results were poorer than those described above. It is concluded that steroids in combination with UVB should be used only during the initial period in order to achieve a more rapid alleviation of symptoms and to avoid the side effects.     

The efficacy and safety of topically applied indigo naturalis ointment in patients with plaque-type psoriasis

BACKGROUND: It has been reported in the Chinese literature that indigo naturalis exhibits potential antipsoriatic effects in systemic therapy. OBJECTIVE: To evaluate the efficacy and safety of topically applied indigo naturalis on treating plaque-type psoriasis and to analyze the histological change in skin tissues. METHODS: Fourteen patients with chronic plaque psoriasis were enrolled. The patients were topically applied with either indigo naturalis ointment or vehicle ointment on contralateral skin lesions daily for 8 weeks. Efficacy was evaluated on the basis of the clinical scores, including induration, scaling, erythema and clearing percentage. At the end of treatment, skin punch biopsies were taken and prepared for the immunohistochemical analysis. RESULTS: A significant reduction in clinical scores was achieved with topically applied indigo naturalis ointment. Analysis of biopsies showed a marked improvement of skin histology. The expressions of proliferating marker Ki-67 and inflammatory marker CD3 were decreased, but the differentiation marker such as filaggrin was increased in the epidermis after indigo naturalis ointment treatment. CONCLUSIONS: The results suggest that topical application of indigo naturalis ointment may be a novel, safe and effective therapy for psoriasis that is mediated, at least in part, by modulating the proliferation and differentiation of keratinocytes in epidermis, as well as by inhibiting the infiltration of T lymphocytes and therefore the subsequent inflammatory reactions in psoriatic lesions.