clobetasol and calcipotriene

The largest proportion of psoriasis patients are candidates for topical treatment rather than treatment paradigms encompassing systemic, biologic and apremilast, and phototherapy, making skillfulness with topical therapy of paramount importance. As such, numerous studies have been conducted to demonstrate the benefits of using topical therapy in combination with other therapies. In addition, innovative uses of otherwise conventional methods, such as proactive use to minimize flare, have been developed. This article reviews five types of strategies for improved efficacy from topical agents beyond monotherapy. These strategies include proactive use, rotational therapy, sequential therapy, using topical agents to shorten the onset of therapeutic action for slower internal agents or phototherapy, and combination use for added efficacy. Each of these is reviewed in detail.

Topics: Administration, Topical; Calcitriol; Clobetasol; Databases, Factual; Dermatologic Agents; Humans; Nicotinic Acids; Phototherapy; Psoriasis; Tacrolimus

The true pathogenic mechanism of vitiligo is still unknown. About half of the patients with this disease have onset before the age of 20 years, making it a serious dermatologic disorder in childhood.. The objective of this study was to review the literature in a systematic way and identify the main pharmacologic treatments and outcomes in children and adolescents with vitiligo.. Four databases-the National Library of Medicine (MEDLINE-PubMed), Web of Science, Scopus, and Latin American and Caribbean Health Sciences (LILACS)-were used for the search up to January 2015. All electronic search titles, selected abstracts and full-text articles were independently reviewed by a minimum of two reviewers.. There were 15 articles from 13 different countries: 3 were retrospective and 12 were prospective; the number of participants in the studies varied between 9 and 400, ages ranged from 0 to 18 years, and the duration of disease ranged from 1 to 17 years. The most commonly used drugs were tacrolimus alone (or combined with clobetasol), pimecrolimus, corticosteroids, and calcipotriol. Treatment duration ranged from 10 days to 6 months with a topical route of administration.. The main outcome measurements were morphometric analysis performed using a computer program, hematologic or biochemical change, and photography (predominant). It is unclear which was the most effective treatment for vitiligo, however, it was found that these therapies are all promising in the treatment of the disease. With proper care, disease control and repigmentation, even if partial, can be achieved.

Topics: Adolescent; Calcitriol; Child; Child, Preschool; Clobetasol; Dermatologic Agents; Glucocorticoids; Humans; Tacrolimus; Treatment Outcome; Vitiligo

Dermatological research continues to move toward the goal of developing an effective psoriasis treatment that would rapidly clear lesions and provide long-term freedom from visible signs and symptoms. Currently, topical corticosteroids remain a pivotal treatment due to their effective anti-inflammatory properties; however, potential adverse effects associated with chronic application limit long-term continuous therapy. Vitamin D analogues provide another mechanism of action, reducing lesions through effects on both keratinocytes and on the cytokine environment. A topical combination of corticosteroid and vitamin D derivative appears to provide a balanced approach to psoriasis treatment. The development of clobetasol propionate foam 0.05% (clobetasol propionate foam/Olux) offers a convenient topical corticosteroid that can be used concomitantly, that is, immediately followed by application of calcipotriene ointment 0.005% (Dovonex). This regimen has been shown to offer an increased short-term efficacy compared with either agent alone. Continued application of calcipotriene ointment on weekdays supplemented by long-term clobetasol propionate foam pulse therapy on weekends appears to provide an enhanced maintenance of remission compared with calcipotriene monotherapy.

Topics: Administration, Cutaneous; Calcitriol; Clobetasol; Dermatologic Agents; Drug Administration Schedule; Drug Therapy, Combination; Humans; Psoriasis

Topics: Adalimumab; Alefacept; Anti-Inflammatory Agents; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Attitude to Health; Betamethasone; Body Image; Calcitriol; Clobetasol; Dermatologic Agents; Diagnosis, Differential; Drug Monitoring; Etanercept; Humans; Immunoglobulin G; Immunosuppressive Agents; Infliximab; Psoriasis; Receptors, Tumor Necrosis Factor; Recombinant Fusion Proteins; Severity of Illness Index

Skin, particularly the uppermost layer--the stratum corneum--presents a formidable, largely impassable barrier to the entry of most compounds. Recently, a novel thermolabile, low-residue foam vehicle, VersaFoam (Connetics Corp, Palo Alto, Calif), has emerged that offers a number of clinical and cosmetic advantages for the delivery of therapeutic agents through the skin. Two corticosteroids--mid-potency betamethasone valerate and ultra-high-potency clobetasol propionate--are now available in this formulation, and other products are in development to deliver clindamycin and ketoconazole in the foam vehicle. A series of in vitro studies have demonstrated that the new foam has the ability to deliver the active drug at an increased rate compared with other vehicles. These findings suggest that the new foam utilizes a nontraditional "rapid-permeation" pathway for the delivery of drugs. It is likely that components within the foam (probably the alcohols) act as penetration enhancers, and reversibly alter the barrier properties of the outer stratum corneum, thus driving the delivered drug across the skin membrane via the intracellular route. This is in contrast to traditional topical delivery vehicles, which must first rely on hydration of the intercellular spaces in the stratum corneum to achieve drug delivery. The latter mechanism reflects a hydration-dependent process, which may result in comparatively slower drug permeation.

Topics: Administration, Cutaneous; Administration, Topical; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Betamethasone; Body Water; Calcitriol; Clindamycin; Clobetasol; Dermatologic Agents; Dosage Forms; Hot Temperature; Humans; Ketoconazole; Ointments; Pharmaceutical Vehicles; Skin; Skin Absorption

A sequential therapy regimen involving an initial clearing phase of daily applications of calcipotriene 0.005% ointment and halobetasol 0.05% ointment for 2 weeks, followed by halobetasol applied twice daily on weekends and calcipotriene applied twice daily on weekdays, has been shown to be effective in the management of chronic plaque psoriasis. As a clearing regimen, the combined use of halobetasol and calcipotriene for 2 weeks was superior to monotherapy with either agent. Subsequently, the use of halobetasol on weekends and calcipotriene on weekdays allowed 76% of patients to stay in remission for up to 6 months, compared with 40% of patients who applied halobetasol on weekends only and placebo on weekdays. Calcipotriene can be inactivated when mixed with some topical preparations; however, halobetasol propionate 0.05% ointment and cream have been shown to be compatible with calcipotriene for up to 2 weeks. The compatibility of calcipotriene and halobetasol permits the use of these agents together.

Topics: Administration, Topical; Calcitriol; Clinical Trials as Topic; Clobetasol; Dermatologic Agents; Drug Administration Schedule; Drug Therapy, Combination; Humans; Ointments; Psoriasis; Treatment Outcome; Vasoconstrictor Agents

Calcipotriene has been shown to be safe and effective for the treatment of psoriasis. For scalp psoriasis, the safety advantage of this nonsteroid agent is as important as its efficacy. Even though monotherapy with calcipotriene solution may not always be efficacious for severe scalp psoriasis, many patients are managed effectively with a sequential therapy regimen consisting of 3 phases. In phase 1 (clearing), patients apply clobetasol solution or gel in the morning and calcipotriene solution in the evening daily for 2 weeks. After the scalp psoriasis improves, clobetasol is reduced to weekends and calcipotriene solution is applied on weekdays (phase 2, transitional). Phase 3 is maintenance on calcipotriene solution alone to prevent recurrence. For patients with recalcitrant scalp psoriasis-where only a clobetasol-strength, superpotent topical corticosteroid is effective-a flip-flop therapy regimen has been proposed that allows for the safe, prolonged use of clobetasol solution by limiting its treatment to twice a day for 2-week periods with the use of calcipotriene solution twice a day for a minimum of 2 weeks during the corticosteroid-free in-between periods.

Topics: Administration, Topical; Anti-Inflammatory Agents; Calcitriol; Clobetasol; Drug Administration Schedule; Drug Therapy, Combination; Gels; Glucocorticoids; Humans; Ointments; Psoriasis; Scalp; Treatment Outcome

Topics: Calcitriol; Clobetasol; Dermatologic Agents; Goals; Humans; Information Services; Internet; Nurse Practitioners; Patient Care Planning; Primary Health Care; Psoriasis; Quality of Life; Vasoconstrictor Agents

Because physicians from different nations frequently acquire the use of a new medication at different times, the international exchange of experiences with the new medication is valuable in maximizing its efficacy worldwide. In recent years, many new therapeutic agents have been approved for treating psoriasis in the United States. These include the topical agent calcipotriol and the systemic agents acitretin and cyclosporine. In addition to new agents, a new therapeutic paradigm, sequential therapy, has been introduced recently. It is the hope of the authors that by sharing this paradigm and experiences with these agents in the United States, dermatologists in Japan may gain further insight into optimizing the use of these agents in the treatment of psoriasis.

Topics: Acitretin; Calcitriol; Clobetasol; Cyclosporine; Dermatologic Agents; Humans; Photochemotherapy; Psoriasis; United States

Side effects of topical corticosteroids limit their long-term use. Calcipotriene/calcipotriol (Dovonex/Daivonex) ointment is not associated with any of the side effects of corticosteroids and has been shown to thicken the skin in contrast to the cutaneous atrophy caused by topical steroids.. We attempted to determine whether the addition of calcipotriene to a regimen of topical steroids results in an improved benefit/risk ratio.. Published and unpublished data on combination regimens were reviewed.. In long-term regimens for psoriasis, substituting calcipotriene for topical corticosteroids may result in a steroid-sparing effect. Conversely, topical corticosteroids may suppress the development of local cutaneous irritation that occurs in patients treated with calcipotriene ointment.. Psoriasis regimens combining calcipotriene ointment with superpotent steroids such as halobetasol ointment can result in greater improvement and fewer side effects.

Topics: Administration, Cutaneous; Anti-Inflammatory Agents; Atrophy; Calcitriol; Clobetasol; Dermatitis, Irritant; Dermatologic Agents; Drug Combinations; Drug Interactions; Glucocorticoids; Humans; Irritants; Longitudinal Studies; Ointments; Psoriasis; Risk; Skin

Alopecia areata (AA) is a common non-scarring hair loss disorder that affects children and adults with a great psychological burden because of its recurrent and sometimes treatment-refractory nature.. To compare the efficacy of topical calcineurin inhibitor, topical potent steroid combined with vitamin D analogue versus topical superpotent steroid in treatment of localized AA.. Sixty subjects with chronic (>1 year) localized (SALT score < 25%) AA, confirmed clinically and dermoscopically, were randomized into three groups. Group I used topical 0.03% tacrolimus (Tarolimus®), group II used topical potent steroid combined with vitamin D analogue (Daivobet®). and group III used topical superpotent steroid (Dermovate®). All patients continued a daily therapy for three successive months and were followed up for three other months. Assessment was done using PULL test, SALT score, and dermoscopic comparison before and after therapy.. Group II showed comparable statistical results to group III with lower values in a non-statistically significant way. Group I achieved the least improvement among all groups.. Combined vitamin D analogues with potent steroid appears to be a more convenient treatment for localized AA than superpotent steroids because of less side effects and comparable efficacy. Tacrolimus needs further research or formula customization to be used as a topical therapy for AA.

Topics: Adult; Alopecia Areata; Child; Clobetasol; Humans; Tacrolimus; Treatment Outcome; Vitamin D

Treatment response for psoriasis is typically evaluated using clinical scores. However, patients can relapse after clinical clearance, suggesting persistent inflammation. Dermoscopy, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) can non-invasively improve treatment response assessment.. To compare the clinical and non-invasive microscopic features in a psoriatic target lesion treated with clobetasol cream or calcipotriol/betamethasone dipropionate foam (Cal/BD foam).. Prospective, unicentric, open, randomized clinical trial comparing clinical data [total clinical score (TCS)] and microscopic data (dermoscopy, RCM and OCT) in psoriasis patients treated with clobetasol or Cal/BD foam.. We included 36 adult patients (22 men). At week 4, more patients treated with Cal/BD foam achieved TCS ≤1 than with clobetasol (63.2% vs. 18.8%, P = 0.016). Treatment satisfaction was higher with Cal/BD foam (P < 0.03). Microscopically, Cal/BD foam induced more reduction in epidermal thickness at week 4 (P < 0.049). Dilated horizontal blood vessels were more common with clobetasol than with Cal/BD foam at week 8 (69.2% vs. 31.2%, P = 0.159). If epidermal hyperplasia was noted at baseline, the response was poorer with clobetasol (P = 0.029).. Small sample size, open study, imaging sampling bias.. Cal/BD foam is more effective than clobetasol, has better patient satisfaction and induces greater reduction in the hyperkeratosis/acanthosis, regardless of baseline epidermal hyperplasia.

Topics: Adult; Betamethasone; Calcitriol; Clobetasol; Dermatologic Agents; Humans; Male; Prospective Studies; Psoriasis; Treatment Outcome

Excimer light, topical vitamin D analogues, and topical steroids have been reported to be effective treatments for vitiligo. However, monotherapy often demonstrates unfavorable results for acral vitiligo. This study aimed to evaluate the efficacy and safety of combination treatment with 308-nm excimer light and topical calcipotriol or topical clobetasol ointment for acral vitiligo. A prospective, randomized, double-blind, and intraindividual study was conducted. Combination treatment (excimer light and topical medication) was applied in the first 12 weeks, and monotherapy (topical medication alone) was used in the later 12 weeks. Both hands were irradiated with excimer light three times a week for 12 weeks. Calcipotriol ointment was randomly assigned to one hand, whereas clobetasol ointment was assigned to the other hand. The ointments were applied twice daily for a total of 24 weeks. Repigmentation, clinical improvement, and adverse reactions were assessed. A total of 26 hands completed the study. Of the hands treated with excimer light and calcipotriol, approximately 8% achieved excellent repigmentation at the end of the combination treatment period and 23% achieved good to excellent improvement after 12 weeks of calcipotriol monotherapy. More than 85% and 77% of the hands treated with calcipotriol-based and clobetasol-based regimens showed some repigmentation at the end of the study, respectively (P < .05). Nevertheless, no significant difference was found between the treatments. No serious adverse reactions were observed. In conclusion, the combination of excimer light and topical calcipotriol followed by topical calcipotriol alone is effective and might be a promising treatment regimen for acral vitiligo.

Topics: Calcitriol; Clobetasol; Dermatologic Agents; Humans; Prospective Studies; Treatment Outcome; Vitiligo

Very few studies have assessed the efficacy of excimer in the treatment of palmoplantar psoriasis (PPP), and none has compared the excimer with calcipotriol-clobetasol propionate combination.. To compare the effectiveness and safety of excimer lamp vs topical ointment containing calcipotriol (0.005% w/w) and clobetasol propionate (0.05% w/w) combination in PPP.. This right-left randomization trial included 36 patients with PPP, who received treatment with excimer lamp (twice weekly) on one side and calcipotriol-clobetasol combination (once daily) on another side for 12 weeks, followed by 8 weeks of follow-up. Recruitment and response assessment was done by 2 experienced dermatologists (SD and TN) using modified palmoplantar pustular psoriasis area and severity index score (mPPPASI, originally devised for palmoplantar pustulosis, suitably modified to assess response in PPP). Primary outcome measure was percentage improvement in mPPPASI at 12 weeks, which was classified as minimal (≤25%), mild (>25%-50%), moderate (>50%-75%), and marked (>75%). Secondary outcome measures were the proportion of patients achieving >75% reduction in mPPPASI and the time taken to achieve it.. Of 36 recruited patients, 33 completed treatment and 21 adhered to 8-weeks follow-up. The mean mPPPASI on the excimer-treated sides reduced significantly from 7.75 ± 4.62 to 4.01 ± 4.07 (P < .001) at 12th week (end of the treatment) and 2.66 ± 3.97 at 20th week (at 8 weeks follow-up). The mean mPPPASI on the calcipotriol-clobetasol combination treated sides reduced significantly from 7.36 ± 4.46 to 3.55 ± 3.77 (P < .001) and 2.70 ± 3.97 at 12th week and 20th week, respectively. The reduction was significant for both treatment and the difference between the two was not statistically significant. Minimal, mild, moderate, and marked improvement was seen in 5/33 (15.2%) and 1/33 (3.0%), 6/33 (18.2%) and 8/33 (24.2%), 12/33 (36.4%) and 13/33 (39.4%), and 8/33 (24.2%) and 8/33 (24.2%) sides in the excimer and calcipotriol-clobetasol combination, respectively. A total of 8 patients in each group achieved mPPPASI 75 at 12 weeks. The mPPPASI 75 was achieved at 2, 4, and 8 weeks in 1, 2, and 8 patients, respectively, using either modalities. The adverse effects (most commonly hyperpigmentation) were noted more frequently on the excimer-treated sides; however, they were well tolerated.. Both excimer lamp and calcipotriol-clobetasol propionate combination are equally effective in the treatment of PPP.

Topics: Adult; Aged; Calcitriol; Clobetasol; Female; Follow-Up Studies; Humans; Male; Middle Aged; Photochemotherapy; Psoriasis; Severity of Illness Index

Topical corticosteroids are widely used in the treatment of psoriasis. This study was conducted to compare the efficacy and safety of clobetasol propionate (CP) 0.005% spray to calcipotriene 0.005%-betamethasome diproprionate 0.064% (C-BD) ointment in patients with moderate to severe plaque psoriasis. Assessments were made at baseline, week 2, week 4 (end of treatment) and week 8 (4 weeks posttreatment). An assessment for Overall Disease Severity (ODS) found that 75% of CP spray-treated patients achieved a rating of clear or almost clear after 4 weeks of treatment compared to 45% of C-BD ointment-treated patients (P=.003). Adverse events were reported by less than one-third of patients from each treatment group (31% for CP spray and 33% for C-BD ointment).

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Betamethasone; Calcitriol; Clobetasol; Dermatologic Agents; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Male; Middle Aged; Ointments; Patient Satisfaction; Psoriasis; Quality of Life

The Clobex Spray Community-Based Research Assessment (COBRA) trial was a 4-week, open-label, observational, community-based trial that evaluated the use of twice-daily clobetasol propionate spray 0.05% either as monotherapy (n = 1254, effectiveness-evaluable [EE] population) or therapy added on to an existing regimen (n = 731, EE population) in subjects with moderate to severe plaque psoriasis. The key outcome measures were the change in target plaque severity (TPS) rating between weeks 0 (baseline) and 4 and the investigators' global assessment of improvement (GAI) rating at 4 weeks. This article focuses on clobetasol spray 0.05% when it is added to the 5 most commonly used treatment regimens in the COBRA trial add-on therapy group. Among the group of subjects receiving clobetasol propionate spray 0.05% as add-on therapy, the most common ongoing treatment was a biologic agent. The other more common ongoing treatments were topical calcipotriene, oral antipsoriatic agents, other topical corticosteroids (non-class 1), and topical calcipotriene plus other topical corticosteroids. Similar rates of treatment success (clear or almost clear) were seen in the subgroup analysis for each of the add-on regimens when assessed by both the TPS and GAI scales. On the TPS scale, success rates at week 4 were 76.0% to 84.0% for clobetasol propionate spray 0.05% added to biologic agents, topical calcipotriene, oral antipsoriatic agents, other topical corticosteroids, or topical calcipotriene plus other topical corticosteroids. It is notable that in subjects who were being treated with a variety of agents, the addition of clobetasol propionate spray 0.05% during the course of the study resulted in improvements in disease severity.

Topics: Administration, Oral; Administration, Topical; Adult; Aged; Biological Products; Calcitriol; Clobetasol; Dermatologic Agents; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Male; Middle Aged; Patient Satisfaction; Psoriasis; Quality of Life; Severity of Illness Index; Skin; Treatment Outcome

The merit of topical sequential therapy involving clobetasol foam and calcipotriene ointment has not been experimentally demonstrated.. We sought to assess the short-term efficacy of twice-daily clobetasol foam plus calcipotriene ointment compared with either agent alone as monotherapy and to compare long-term use of weekday calcipotriene ointment with or without clobetasol foam weekend pulse therapy.. Eighty-six subjects with plaque-type psoriasis received twice-daily treatment with clobetasol foam plus calcipotriene ointment or either agent as monotherapy for 2 weeks. Subjects in the combination group who achieved remission received weekday calcipotriene plus weekend pulse therapy with either clobetasol foam or vehicle for 6 months.. After 2 weeks, psoriasis scores were significantly lower (P < .001) in the combination therapy group (adjusted trunk lesion score = 0.67) compared with monotherapy with either agent (lesion scores = 1.40 calcipotriene, 1.13 clobetasol foam). During the follow-up "weekday-weekend" phase, after 6 months, weekend pulse clobetasol foam was associated with a trend toward greater maintenance of remission compared with vehicle (92% improvement of trunk lesion vs 62%).. Small sample size may have hampered the detection of statistical significance during long-term therapy.. The combination of clobetasol foam and calcipotriene ointment is significantly more effective than monotherapy for short-term treatment. Weekday calcipotriene plus weekend pulse clobetasol foam shows a consistent trend toward greater maintenance of remission.

Topics: Adult; Calcitriol; Clobetasol; Dosage Forms; Drug Administration Schedule; Female; Humans; Male; Ointments; Psoriasis; Time Factors; Treatment Outcome

Scalp involvement in psoriatic patients represents a common issue. Treatment of the hairy skin requires adequate pharmaceutical formulations; hence, a new specific shampoo formulation of clobetasol propionate 0.05% was developed by Galderma R&D, Inc.. For this multicenter, randomized, investigator-masked, parallel group study, 151 subjects with moderate to severe scalp psoriasis were randomized to 4 weeks of treatment with clobetasol propionate shampoo or calcipotriol solution.. Clobetasol propionate demonstrated significantly superior efficacy to calcipotriol solution (total severity score: mean difference 0.51, 95% CI 0.05-0.97, p = 0.028; global severity score: mean difference 0.43, 95% CI 0.08-0.78, p = 0.016). Adverse events were more common in the calcipotriol group than in the clobetasol propionate shampoo group. Telangiectasia and skin atrophy did not differ significantly between treatments; however, a burning sensation was significantly more common in the calcipotriol solution group.. Short contact therapy of scalp psoriasis with this new shampoo formulation of clobetasol propionate was significantly more effective and better tolerated than calcipotriol solution for the treatment of scalp psoriasis.

Topics: Administration, Topical; Adult; Calcitriol; Clobetasol; Dermatologic Agents; Female; Hair Preparations; Humans; Male; Middle Aged; Psoriasis; Scalp Dermatoses; Severity of Illness Index; Solutions; Treatment Outcome

Various studies have shown the blocking effects of topical agents on UVB penetration, which can be used in combination with phototherapy. In this study, the photoprotective effects of 0.005% calcipotriol, 0.05% clobetasol-17-propionate, and 0.1% tretinoin, which can be used in combination with broad-band UVB, were investigated in an in vivo test. In a study group of 20 patients, phototests were performed to determine minimal erythema doses (MED) and the tests were repeated with thin (0.1 cc/25 cm2) and thick (0.3 cc/25 cm2) calcipotriol, clobetasol-17-propionate, and tretinoin in cream forms and sunscreen. After determining the MED, the test was repeated in another 20 patients with thin and thick calcipotriol and clobetasol-17-propionate in both cream and ointment forms and sunscreen. MED was increased with thin and thick applications of all agents. Moreover, the photoprotective effects of each agent increased with their thick applications compared with thin ones. The application of calcipotriol cream and ointment, clobetasol cream and ointment, and tretinoin cream, all of which can block UVB, is not recommended just before phototherapy.

Topics: Adult; Calcitriol; Clobetasol; Dermatologic Agents; Erythema; Humans; Ointments; Reference Values; Single-Blind Method; Tretinoin; Ultraviolet Rays

We investigated the value of the dermoscope for monitoring the long term safety of high potency topical steroids in patients with chronic psoriasis. We observed for the first time that the overuse of topical steroids resulted in the appearance of clinically unapparent but dermoscopically apparent "red lines" (linear telangiectasias) in the treated plaques and/or skin adjacent to the treated plaques (P < .03). We concluded that dermoscopy may help reveal the early signs of impending steroid-induced atrophy ("red lines") before they become clinically evident with the naked eye and before the atrophy becomes permanent.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Atrophy; Calcitriol; Chronic Disease; Clobetasol; Dermatologic Agents; Dermoscopy; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Patient Compliance; Pilot Projects; Psoriasis

Topics: Administration, Topical; Anti-Inflammatory Agents; Calcitriol; Clobetasol; Dermatologic Agents; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Male; Middle Aged; Nail Diseases; Ointments; Psoriasis

Both calcipotriene and tazarotene have been shown to be effective in the treatment of psoriasis. No study has evaluated the effect of using both agents simultaneously.. Our purpose was to evaluate the effectiveness of combination treatment of psoriasis with calcipotriene ointment and tazarotene gel by comparing them with clobetasol ointment, a class I topical corticosteroid. A secondary objective was to evaluate the clinical compatibility of applying both agents at the same time.. This pilot study was a prospective, single-center, open-label, right/left comparison of 28 lesion pairs in 15 patients. It consisted of a 2-week treatment phase, followed by a 4-week post-treatment observation phase.. All 15 patients completed the treatment phase of the study. At the end of the active treatment phase (end of week 2), calcipotriene- and tazarotene-treated lesions showed nearly identical reductions in scaling (P =.93), plaque elevation (P =.76), and overall lesional severity scores (P =.29) compared with their matched clobetasol-treated counterparts. Erythema improved significantly more in clobetasol-treated lesions (P <.05) during the treatment period, but differences became statistically insignificant during the post-treatment period (;P =.20). No patients had significant irritation from the treatments. During the post-treatment phase (weeks 3-6), all lesions worsened; plaque elevation returned somewhat more rapidly in calcipotriene- and tazarotene-treated lesions (P <.01), whereas changes in scaling, erythema, and overall lesional severity were not significantly different between the two treatment groups (P >.05).. The nonsteroid combination of twice-daily calcipotriene ointment and once-daily tazarotene gel was not statistically different from twice-daily application of the class I corticosteroid clobetasol ointment in reducing psoriatic scaling, plaque elevation, and overall lesional severity over a 2-week period. There does not seem to be any chemical incompatibility between calcipotriene ointment and tazarotene gel that is clinically significant.

Topics: Administration, Cutaneous; Anti-Inflammatory Agents; Arm; Calcitriol; Clobetasol; Dermatologic Agents; Drug Synergism; Drug Therapy, Combination; Elbow; Female; Gels; Glucocorticoids; Humans; Leg; Male; Nicotinic Acids; Ointments; Pilot Projects; Prospective Studies; Psoriasis; Severity of Illness Index; Thorax; Treatment Outcome

This study describes the changes in number and distribution of somatostatin- and factor XIIIa-immunoreactive dendritic cells in the epidermis and dermis of psoriatic lesional skin during topical treatment with clobetasol propionate or calcipotriol. Immunohistochemical analysis showed that the number of each cell type was increased in lesional skin as compared to normal skin. Investigation of serial biopsies from psoriasis lesions revealed a significant reduction in the number of somatostatin- and factor XIIIa-positive dendritic cells during the treatments. The reduction rate of the somatostatin-positive cells differed between the two groups and closely paralleled the healing process induced by the two treatments. These findings and the fact that somatostatin has been used in several studies as treatment for psoriasis may indicate that the somatostatin-positive cells are specifically involved in the healing process of psoriasis. The reduction of the factor XIIIa-positive cells was associated with the healing process as a whole, but showed no relation to either treatment.

Topics: Adult; Biopsy; Calcitriol; Clobetasol; Dendritic Cells; Dermatologic Agents; Female; Fluorescent Antibody Technique, Indirect; Glucocorticoids; Humans; Immunohistochemistry; Male; Middle Aged; Psoriasis; Skin; Somatostatin; Transglutaminases

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.. To investigate whether 2 weeks of treatment with clobetasol propionate 0.05% ointment bd followed by 4 weeks of treatment with calcipotriol 50 microg/g bd would offer therapeutic advantages over 6 weeks of continuous treatment with calcipotriol.. 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.. 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.. 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.

Topics: Administration, Topical; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Calcitriol; Clobetasol; Dermatitis, Irritant; Dermatologic Agents; Double-Blind Method; Drug Therapy, Combination; Female; Follow-Up Studies; Glucocorticoids; Humans; Male; Middle Aged; Patient Satisfaction; Physician's Role; Program Evaluation; Pruritus; Psoriasis; Purpura; Severity of Illness Index; Skin; Treatment Outcome

Weekend therapy with superpotent topical corticosteroids has been used for the long-term treatment of psoriasis. Recently, calcipotriene ointment has been added to this regimen for use on weekdays, but there are no long-term studies of that combination.. The purpose of this study was to determine whether the addition of weekday calcipotriene to a pulse therapy regimen of weekend superpotent corticosteroids results in a longer duration of remission of plaque psoriasis.. This was a double-blind, placebo-controlled, parallel-group study. Forty-four patients with mild to moderate psoriasis were treated with calcipotriene ointment in the morning and halobetasol ointment in the evening for 2 weeks. Thereafter, 40 patients who were at least moderately (50% or greater) improved were randomized to 2 treatment groups. After 2 weeks of treatment with calcipotriene ointment in the morning and halobetasol ointment in the evening, 20 patients were randomized to receive halobetasol ointment twice daily on weekends and calcipotriene ointment twice daily on weekdays, and 20 patients were randomized to receive halobetasol ointment twice daily on weekends and placebo ointment twice daily on weekdays.. Seventy-six percent of patients applying halobetasol ointments on weekends and calcipotriene ointment on weekdays were able to maintain remission for 6 months compared with 40% of patients applying halobetasol ointment on weekends only with the vehicle on weekdays.. The addition of calcipotriene ointment applied on weekdays to a weekend pulse therapy regimen of superpotent corticosteroids can increase the duration of remission of psoriasis.

Topics: Administration, Topical; Adult; Calcitriol; Clobetasol; Dermatologic Agents; Double-Blind Method; Drug Administration Schedule; Humans; Ointments; Psoriasis; Time Factors

The objectives of the study were to determine whether concurrent treatment with calcipotriol (50 microg/g) and either clobetasone 17-butyrate cream (0.5 mg/g) (moderate potency) or betamethasone 17-valerate cream (1 mg/g) (potent) or placebo (vehicle of calcipotriol) was more effective and/or caused less skin irritation than calcipotriol cream (50 microg/g) used twice daily. It was a multicentre, double-blind, parallel group study. Patients applied calcipotriol cream in the morning and either vehicle (n = 174), calcipotriol (n = 174), clobetasone (n = 175) or betamethasone creams (n = 176) in the evening for up to 8 weeks. Adverse events led to withdrawal in 20 patients (2.9%). The mean percentage change in PASI (psoriasis area and severity index) was -40.6 in the calcipotriol/vehicle group, -48.3 in the calcipotriol/calcipotriol group, -53.7 in the calcipotriol/clobetasone 17-butyrate group and -57.5 in the calcipotriol/betamethasone 17-valerate group. A statistically significant difference was seen between the four treatment groups (P = 0.006) with calcipotriol/vehicle being less effective than the other treatments. A statistically significant difference in favour of calcipotriol/betamethasone 17-valerate was seen between the calcipotriol/calcipotriol group and the calcipotriol/betamethasone 17-valerate group. The majority of adverse events were skin irritations, which were reported for 31.2% of patients treated with calcipotriol/vehicle, 34.3% of patients treated with calcipotriol twice daily and 23.8% vs. 17.1% of patients treated with calcipotriol/clobetasone 17-butyrate and calcipotriol/betamethasone 17-valerate, respectively. Skin irritation was seen statistically significantly less frequently in patients treated with calcipotriol/ clobetasone 17-butyrate or calcipotriol/betamethasone 17-valerate (P = 0.001), whereas no difference was seen between the other groups. In conclusion, calcipotriol applied twice daily was as effective as calcipotriol/clobetasone 17-butyrate, but slightly less effective than calcipotriol/betamethasone 17-valerate. The incidence of skin irritation was less for patients using concurrent corticosteroids, whereas treatment with calcipotriol/vehicle did not reduce the incidence of skin irritation when compared with calcipotriol twice daily.

Topics: Adult; Anti-Inflammatory Agents; Betamethasone; Calcitriol; Clobetasol; Dermatologic Agents; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Male; Psoriasis; Treatment Outcome

Topics: Administration, Cutaneous; Adult; Calcitriol; Clobetasol; Dermatologic Agents; Drug Combinations; Female; Humans; Male; Ointments; Psoriasis; Remission Induction; Vasoconstrictor Agents

Reports of purported sensitization reactions to widely used prescription dermatologicals have raised questions concerning the clinical significance of these reports. The current study was designed to compare irritant and sensitization potentials of such marketed products and to evaluate the risks involved in their usage.. One hundred and eight healthy adult volunteers were evaluated for primary irritation and hypersensitivity following application under a double-blind paradigm of eight leading prescription dermatologic products and the vehicle cream of one product according to an intensified version of the Shelanski and Shelanski "Repeated Insult Patch Test.". No clinically significant irritant or sensitization reactions were associated with applications of topical formulations containing clobetasol propionate, doxepin hydrochloride, metronidazole, mupirocin, oxiconazole nitrate, and terbinafine hydrochloride. The doxepin hydrochloride cream vehicle was also found to be nonirritating and nonsensitizing. Both calcipotriene and ketoconazole were moderate irritants and possible sensitization reactions were also associated with ketoconazole.. Although every topically applied chemical has the potential to cause an adverse response in some individuals, the data obtained in this study for eight commercially available prescription dermatologic products indicate that most are quite safe and have very low risks of clinically significant irritation or sensitization.

Topics: Adult; Aged; Aged, 80 and over; Allergens; Antifungal Agents; Calcitriol; Clobetasol; Dermatitis, Irritant; Dermatologic Agents; Double-Blind Method; Doxepin; Drug Prescriptions; Female; Humans; Hypersensitivity; Imidazoles; Irritants; Ketoconazole; Male; Metronidazole; Middle Aged; Mupirocin; Naphthalenes; Patch Tests; Pharmaceutical Vehicles; Placebos; Risk Factors; Skin; Terbinafine

Calcipotriol and corticosteroids, two therapy modalities frequently prescribed in the treatment of psoriasis, are often used in combination. The aim of the present study was to determine whether the cell biological response pattern of concurrent use of calcipotriol and corticosteroids is different from calcipotriol monotherapy. Forty patients with chronic plaque psoriasis were divided at random in four parallel groups and treated for 8 weeks with: (1) calcipotriol cream (50 micrograms/g once daily); (2) calcipotriol cream twice daily; (3) calcipotriol and clobetasone 17-butyrate (0.5 mg/g) creams; and (4) calcipotriol and betamethasone 17-valerate (1 mg/g) creams. Before and after treatment keratotome biopsies were taken and single cell suspensions prepared for flow cytometric analysis. Flow cytometric multiparameter quantification of markers for proliferation (TO-PRO-3), differentiation (antikeratin 10) and inflammation (antivimentin) was used to evaluate all four therapy modalities. A statistically significant decrease of the percentage of basal cells in S- and G2M-phase (proliferation) was obtained with all therapy modalities, except for calcipotriol monotherapy applied once daily. A significant reduction of the number of vimentin-positive cells (non-keratinocytes) was observed following combined treatment with calcipotriol and clobetasone butyrate. In contrast, monotherapy with calcipotriol had virtually no effect on the number of vimentin-positive cells. It can be concluded that: (i) calcipotriol monotherapy, applied once daily was less antiproliferative compared with twice daily applications of calcipotriol or the combined treatment with corticosteroids and that (ii) the combination of calcipotriol and corticosteroids proved to have a marked effect on the percentage of non-keratinocytes, in contrast to the modest effect of calcipotriol.

Topics: Administration, Topical; Anti-Inflammatory Agents; Betamethasone Valerate; Calcitriol; Cell Division; Clobetasol; Dermatologic Agents; DNA; Drug Administration Schedule; Drug Therapy, Combination; Epidermis; Flow Cytometry; Glucocorticoids; Humans; Keratins; Psoriasis; Vimentin

Topical treatment of psoriasis with calcipotriol has been proven effective. The efficacy of calcipotriol has been compared to that of topical corticoids in a number of studies using subjective visual scoring systems such as the PASI index. The purpose of this study was to compare, with objective data, the efficacy of calcipotriol and clobetasol propionate 0.05% in the treatment of plaque type psoriasis. Transepidermal water loss (TEWL) and laser Doppler velocimetry (LDV) were used to monitor restoration of water barrier and normalization of blood flow, respectively, in psoriatic plaques of the limbs of 24 male patients during 3 weeks of treatment. Data were compared to subjective evaluation using the PASI index of the same areas. Significant differences were recorded during treatment in both groups. The results correlated well with the PASI score. Clobetasol was faster in restoring barrier function than calcipotriol. However, no significant differences were detected between the two groups. The use of vitamin analogues may be effective in the topical treatment of psoriasis by normalizing skin biophysical parameters and minimizing the risks of side-effects induced by potent topical corticoids.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Calcitriol; Clobetasol; Dermatologic Agents; Humans; Laser-Doppler Flowmetry; Male; Middle Aged; Psoriasis; Regional Blood Flow; Skin; Water Loss, Insensible

In this study, we investigated the effect of calcipotriol, prednicarbate and clobetasol 17-propionate on skin thickness over a treatment period of 6 weeks. The study was conducted as a controlled, randomized, double-blind comparison. The influence of these drugs on normal skin under occlusive conditions was assessed visually and by measuring skin thickness using 20 MHz B mode ultrasound. Both topically applied glucocorticosteroids lead to a significant decrease in skin thickness. In contrast to the glucocorticosteroid-induced atrophy, calcipotriol application on normal skin leads to an increase in skin thickness in all volunteers. The effect remains constant for the duration of treatment. The cause of this increase seems to be an irritative reaction of the skin which was histologically investigated in one volunteer. The histological features of this reaction are characteristic for a subacute dermatitis. The implications of these findings for the therapeutic mechanism of calcipotriol are discussed.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Atrophy; Calcitriol; Clobetasol; Dermatitis, Contact; Dermatologic Agents; Double-Blind Method; Female; Glucocorticoids; Humans; Male; Middle Aged; Prednisolone; Skin; Ultrasonography

Topics: Adult; Calcitriol; Clobetasol; Colloids; Dermatologic Agents; Female; Humans; Male; Occlusive Dressings; Psoriasis; Single-Blind Method

Topics: Betamethasone; Calcitriol; Clobetasol; Humans; Nicotinic Acids; Psoriasis

Topics: Betamethasone; Calcitriol; Clobetasol; Humans; Nicotinic Acids; Psoriasis

Optimizing combinations for psoriasis means asking patients to take control of their disease. It means balancing potency of steroids for the short-run to put out the fire and bring relief and maintaining the clearance for the long-run to reduce recurrence potential. Successful combinations are built on tolerability, ease of application, and the efficacy demonstrated by the synergy of the sum of the parts over being used separately.

J Drugs Dermatol. 2018;17(3):342-346.

Topics: Administration, Cutaneous; Adult; Aged; Anti-Inflammatory Agents; Calcitriol; Clobetasol; Dermatologic Agents; Drug Delivery Systems; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Middle Aged; Psoriasis; Single-Blind Method; Treatment Outcome

Current work reports the development and optimization of clobitasol propionate (CP) and calcipotriol (CT) loaded nanoemulsion based gel for topical treatment of psoriasis. Components of nanoemulsion viz., oil and surfactant/co-surfactant were selected depending upon solubility and emulsification potential respectively. The optimized ratio of 5:3:2 of Capmul MCM C8 EP, Cremophor RH 40 and Labrafil 1944 CS was selected. Carbopol 980 was used as gelling agent to achieve final drug concentration of 0.05% w/w and 0.005% w/w respectively for CP and CT. HaCaT cell lines showed higher uptake of drug from nanoemulsion in correlation with the enhancement in penetration of both drugs in stratum corneum (SC) and viable layer from nanoemulsion and gel as compared to free drugs. Imiquimod induced psoriatic BALB/c mice revealed significantly higher anti-psoriatic activity of nanoemulsion gel as compared to free drugs and marketed formulation. The developed formulation showed negligible skin irritation despite increased penetration into the skin.

Topics: Animals; Anti-Inflammatory Agents; Calcitriol; Cell Line; Clobetasol; Dermatologic Agents; Drug Combinations; Drug Liberation; Emulsions; Gels; Humans; Interleukin-6; Mice, Inbred BALB C; Nanoparticles; Psoriasis; Skin Absorption; Swine; Tumor Necrosis Factor-alpha

Variably considered as a localized subtype of pustular psoriasis, palmoplantar pustulosis (PPP) is commonly treated with topical steroids, acitretin, and local phototherapy with oral or topical psoralen (PUVA). The utility of acitretin for PPP is limited by adverse effects such as myalgias and an extended risk of teratogenicity in female patients. Isotretinoin is a more tolerable retinoid with a shorter teratogenic window, but to date its effectiveness in PPP has not been reported. Herein we present two patients with PPP who responded well to isotretinoin treatment.. Two patients with PPP refractory to topical therapies were started on acitretin. Both patients developed adverse effects (including headache, myalgias, and mood alterations) leading to acitretin discontinuation. Isotretinoin monotherapy was started in one patient resulting in significant clearing of palmar plaques and scale, and the addition of isotretinoin to UVA therapy resulted in near-complete clearing of recalcitrant plantar plaques in the second patient.. Acitretin represents an important treatment for PPP, but is limited by adverse effects and extended teratogenicity. Our experience supports the utility of isotretinoin as a potential therapeutic alternative, which may be particularly beneficial in patients who are poor candidates for or unable to tolerate acitretin therapy.

Topics: Acitretin; Anti-Inflammatory Agents; Biopsy; Calcitriol; Ceramides; Cholesterol; Clobetasol; Combined Modality Therapy; Diagnostic Errors; Drug Combinations; Drug Substitution; Eczema; Emollients; Fatty Acids; Female; Humans; Isotretinoin; Male; Middle Aged; Psoriasis; Ultraviolet Therapy

Topics: Acrodermatitis; Administration, Cutaneous; Aged; Anti-Inflammatory Agents; Calcitriol; Clobetasol; Diagnosis, Differential; Fingers; Hand Dermatoses; Humans; Male; Nails, Malformed

The interleukin-23/interleukin 17A (IL-23/IL-17A) cytokine axis plays a critical role in the pathogenesis of psoriasis. In this study, we report the effects of topical calcipotriol, camptothecin, clobetasol and tazarotene on the treatment of imiquimod (IMQ)-induced psoriasis-like inflammation, the development of which is dependent on the IL-23/IL-17A axis. IMQ-induced epidermal hyperplasia and inflammation in the BALB/c mouse ear were significantly inhibited following clobetasol treatment but not calcipotriol, camptothecin or tazarotene treatments. Real-time polymerase chain reaction showed that the mRNA levels of IL-17A, IL-17F, IL-22, IL-1β, IL-6 and TNF-α in ear skin were significantly decreased by clobetasol. In addition, we observed that calcipotriol, camptothecin and tazarotene failed to show any inhibitory effects on the IL-23/IL-17A/IL-22 axis. We also found that clobetasol treatment inhibited the proliferation of γδ T cells and C-C chemokine receptor type 6 (CCR6) expression induced by IMQ. Calcipotriol, camptothecin and tazarotene not only failed to inhibit this proliferation but also enhanced retinoic acid-related orphan receptor γ (RORγ) expression in IMQ-induced psoriasis-like inflammation. In conclusion, we suggest that clobetasol induces the relief of IMQ-induced psoriasis-like inflammation in a mouse model but that calcipotriol, camptothecin and tazarotene cannot. Therefore, we suggest that more in-depth studies on pharmacological effects of tazarotene, camptothecin and calcipotriol should be carried out.

Topics: Adjuvants, Immunologic; Administration, Topical; Aminoquinolines; Animals; Anti-Inflammatory Agents; Calcitriol; Camptothecin; Clobetasol; Dermatologic Agents; Disease Models, Animal; Humans; Imiquimod; Mice; Mice, Inbred BALB C; Nicotinic Acids; Psoriasis; Topoisomerase I Inhibitors

Topics: Administration, Cutaneous; Anti-Inflammatory Agents; Attitude of Health Personnel; Betamethasone; Calcitriol; Clobetasol; Dihydroxycholecalciferols; Dose-Response Relationship, Drug; Drug Prescriptions; Gels; Humans; Immunosuppressive Agents; Medication Adherence; Practice Patterns, Physicians'; Psoriasis

Topics: Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Arthroplasty, Replacement, Hip; Calcitriol; Clobetasol; Cyclosporine; Dermatologic Agents; Drug Therapy, Combination; Femur Head; Hip; Humans; Male; Middle Aged; Osteonecrosis; Psoriasis; Quality of Life; Range of Motion, Articular; Severity of Illness Index; Treatment Outcome

Psoriasis is among the top dermatologic diagnoses for older adult patients, and the number of older adult psoriasis patients is expected to rise.. To characterize trends in older adult psoriasis health care practices of US ambulatory physician offices from 1993 to 2009.. We used data from the National Ambulatory Medical Care Survey to assess demographics, specialties seen, and treatment in visits by older adult patients, 55 years of age and older.. There were approximately 14.1 million outpatient visits for psoriasis among the older adult population during the study period. Older adult psoriasis patients were 52.4% female and 47.6% male. The most frequent older adult age group seen for psoriasis was the 55 to 64 year age group. Dermatologists saw 69.3% of patients, internists saw 14.5%, and general and family practitioners saw 11.6%. Topical corticosteroids were the most frequently prescribed medications. Dermatologists preferred clobetasol whereas non-dermatologists more commonly prescribed betamethasone. For both the 18 to 54 year age group and the 55 and older group, the leading 7 out of 10 medications prescribed were topical corticosteroids and calcipotriene. However, etanercept, coal tar, and fluocinolone were among the leading medications in the younger group but not in the 55 and older group.. Treatment approach for older adult psoriasis patients showed some differences among medical specialties and among the younger and older age groups. Further research specific to older adult psoriasis patients is needed to determine optimal treatment strategies for this patient population.

Topics: Administration, Cutaneous; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Ambulatory Care; Betamethasone; Calcitriol; Clobetasol; Coal Tar; Dermatologic Agents; Dermatology; Etanercept; Family Practice; Female; Fluocinolone Acetonide; Glucocorticoids; Health Care Surveys; Humans; Immunoglobulin G; Immunologic Factors; Internal Medicine; Keratolytic Agents; Male; Middle Aged; Practice Patterns, Physicians'; Psoriasis; Receptors, Tumor Necrosis Factor; United States; Young Adult

Topical corticosteroids such as hydrocortisone-17-butyrate (HCB) and clobetasol-17-propionate (CP) and vitamin D(3) derivatives such as calcipotriol (CAL) are widely used to treat psoriasis. The immunosuppressive effects of corticosteroids make their topical use a concern for skin carcinogenicity. Few studies have assessed the effect of topical corticosteroids and topical vitamin D(3) derivatives on photocarcinogenesis induced by ultraviolet radiation. We investigated whether HCB, CP, or CAL can accelerate photocarcinogenesis using simulated solar radiation (SSR). HCB, CP, or CAL was applied topically to the backs of hairless, female, C3.Cg/TifBomTac-immunocompetent mice in 16 groups of 25 mice each. The drugs were applied three times weekly followed by 0, 2, 4, or 6 standard erythema doses (SED) of SSR for 365 days or until death. No change was observed in the time required for tumor development in mice treated with HCB and 2 SED (HCB-2SED) and HCB-6SED. However, the time required for tumor development increased with HCB-4SED treatment. Treatment with CP-2SED did not change the time to onset of the first and second tumor, but all other CP treatments in combination with SSR increased the time. CAL-2SED decreased the time to onset of the first tumor but not of the second and third tumor. CAL-4SED and CAL-6 SED did not change or increased the time to tumor development. Our data indicated that topical administration of HCB and CAL did not alter the photocarcinogenesis of SSR and that topical CP administration had a photoprotective effect. Thus, HCB, CP, and CAL do not increase photocarcinogenesis induced by SSR.

Topics: Administration, Topical; Animals; Body Weight; Calcitriol; Carcinoma, Squamous Cell; Clobetasol; Dermatologic Agents; Female; Hydrocortisone; Kaplan-Meier Estimate; Mice; Mice, Hairless; Neoplasms, Radiation-Induced; Skin; Skin Neoplasms; Skin Pigmentation; Sunlight; Ultraviolet Rays

Topics: Adolescent; Calcitriol; Clobetasol; Dermatologic Agents; Humans; Male; Ointments; Psoriasis

Topics: Acitretin; Anti-Inflammatory Agents; Betamethasone; Calcitriol; Clobetasol; Dermatologic Agents; Friends; Glucocorticoids; Humans; Male; Middle Aged; Prednisone; Prescription Drugs; Psoriasis

Psoriasis requires lifelong treatments that depend on the extent, clinical forms and associated conditions.. To retrospectively analyze which topical treatments were used, their efficacy, and potential advantages and disadvantages.. A total of 666 patients admitted for the first time over 15 years who were topically treated were retrospectively reviewed and subdivided using clinical forms and PASI into four groups and four subgroups for the applied treatments. For each treatment the mean PASI was calculated daily: on the first, third and sixth day. An X sample statistical analysis and Mann--Whitney U-test were performed. The hospitalization time and correlation with the response to treatment were analyzed.. A statistically significant response was recorded for every regimen. The best combination was clobetasol propionate plus eosin on alternate days with eosin plus cade oil. The highest score was recorded for the 'en plaques' psoriasis. The average length of treatment was of 7.5 days in the best combination. No statistically significant difference among the groups was recorded with respect to the length of hospitalization and PASI.. The statistically significant response for all the topical treatments analyzed and recorded in this study does not exclude a potential benefit due to hospitalization per se.

Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Calcitriol; Clobetasol; Dermatologic Agents; Drug Therapy, Combination; Eosine Yellowish-(YS); Female; Humans; Male; Middle Aged; Plant Extracts; Psoriasis; Retrospective Studies; Severity of Illness Index; Skin; Statistics, Nonparametric; Treatment Outcome

Psoriasis presents many management complexities. A cornerstone of therapy has been topical corticosteroids, although over the past 10 years there have been many additions to the medication armamentarium. Furthermore, various combination regimens and approaches have been advocated.. We sought to characterize various patterns of psoriasis health care delivery and the changes associated with these patterns from 1990 to 2001.. Visits for psoriasis were identified using National Ambulatory Medical Care survey data, a representative survey of visits to physician offices in the United States. We determined basic demographic characteristics, specialty of the physician provider and medications listed at these visits over the 1990-2001 interval.. There were more than 13.5 million visits for psoriasis during the 12-year study period. Dermatologists were responsible for the majority of the visits over the study interval (82%) although there was an overall decline in the proportion of psoriasis visits to dermatologists. As a category, the most common medications used for psoriasis were topical steroids. Topical calcipotriene was the single-most listed medication. There was no observed use of non-corticosteroid topical agents at visits to non-dermatologists. Non-dermatologists were as likely as dermatologists to list a systemic medication at a visit as well as use a systemic as monotherapy.. In conclusion, the primary topical therapies for psoriasis remain clobetasol and calcipotriene. The decreasing role of dermatologists in the treatment of psoriasis is probably a complex issue, but may relate in part to the difficulty of obtaining access to dermatology care.

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Aged; Calcitriol; Clobetasol; Dermatologic Agents; Drug Therapy, Combination; Drug Utilization; Female; Health Care Surveys; Humans; Male; Methotrexate; Middle Aged; Office Visits; Psoriasis; Triamcinolone; United States

Because the etiopathogenesis of depigmentation in vitiligo is still obscure, the source of pigmentation in the repigmentating lesion and its stability is also not fully known. Several authors have shown on histopathology and electron microscopy predominantly a perifollicular spread of pigment. The aim of this study was to clinically assess the types of repigmentation patterns obtained with different treatment modalities and their correlation with speed and stability of repigmentation. A total of 125 patients with vitiligo on treatment with psoralens (topical and systemic psoralen-UVA [PUVA]), steroids (both topical and systemic), and topical calcipotriol, alone or in combination were enrolled. Representative lesions of vitiligo excluding mucosal sites were selected in each patient and photographed at baseline. Repigmentation was assessed and labeled as marginal, perifollicular, diffuse, or combined. The preselected patches were evaluated at 3 months to assess the speed of repigmentation. Retention of pigment (stability) was noted at 6 months, after the stoppage of active treatment. Of the 352 vitiligo patches selected, 194 (55%) showed predominant perifollicular repigmentation, of which a majority (127; 65.5%) were on systemic PUVA and 35 (18%) were on topical PUVA. Diffuse pigmentation was observed in 98 patches (27.8%) of which 66 (67.3%) were on topical steroids. Marginal repigmentation was seen in 15, of which the majority (80%) were on systemic PUVA and topical calcipotriol. Of the 28 total lesions showing marked repigmentation at 3 months, 22 lesions pigmented in a diffuse manner, 2 in a perifollicular pattern, and 4 showed a combined type of repigmentation. On follow-up, marginal repigmentation was the most stable (93.3%), followed by perifollicular (91.7%) and combined type (84.4%). Diffuse repigmentation was the least stable (78.5%). Psoralens predominantly exhibit a perifollicular pattern of repigmentation and steroids (topical/systemic), a diffuse type. The speed of repigmentation is much faster when initial repigmentation is of the diffuse type as compared with follicular repigmentation. The marginal and perifollicular repigmentation is more stable than the diffuse type of repigmentation.

Topics: Adolescent; Adult; Calcitriol; Child; Child, Preschool; Clobetasol; Dermatologic Agents; Female; Humans; Male; Middle Aged; PUVA Therapy; Time Factors; Vitiligo

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Calcitriol; Clinical Trials as Topic; Clobetasol; Dermatologic Agents; Female; Glucocorticoids; Humans; Male; Ointments; Vitiligo

Tazarotene is the first receptor-selective retinoid indicated for the topical treatment of plaque psoriasis. It is being used clinically in combination with other topical antipsoriatic treatments, although its stability in the presence of these products has not been examined extensively. This study examines the compatibility of tazarotene 0.05% gel with 17 other topical products used in the treatment of psoriasis, assessed over a 2-week period. Tazarotene showed minimal degradation (<10%) at 0, 8, 24, and 48 hours after compounding with each of the 17 products. In addition, after 1 and 2 weeks, degradation of tazarotene remained less than 10% for 15 of the 17 products tested. Tazarotene appeared to have minimal impact on the stability of the other products. These results suggest that tazarotene gel can be successfully coprescribed with a range of commonly used topical psoriasis treatments without adversely affecting the chemical stability of either agent.

Topics: Administration, Topical; Betamethasone; Calcitriol; Clobetasol; Dermatologic Agents; Drug Evaluation, Preclinical; Drug Incompatibility; Fluocinonide; In Vitro Techniques; Mometasone Furoate; Nicotinic Acids; Pregnadienediols; Psoriasis

Formaldehyde-releasing preservatives are well-known allergens found in many topical preparations including medications.. To analyze the relevance of a positive patch test to formaldehyde-releasing preservatives in medications containing these preservatives.. Patients were recruited with a history of allergy to one of these preservatives. Patch and use testing to the medications, vehicles, and preservatives were performed. The following medications and their respective preservatives were used: Renova 0.05% cream/quaternium-15, Dovonex 0.005% cream/diazolidinyl urea, and Temovate-E 0.05% cream/diazolidinyl urea.. Nine patients participated in the study. A positive patch test to the preservative was reproduced in six of nine patients, and a questionable reaction occurred in one. Two patients had a positive patch test to the topical medication and one a questionable reaction. There were no definitive positive patch tests to the vehicle but two questionable ones. Use testing revealed three positive reactions to Renova, one to Renova vehicle, and one to Temovate-E vehicle.. The concentration of the preservative in the commercial preparation was often below the threshold necessary to produce a clinical reaction. Use testing is a valuable tool in the complete evaluation of the patient with a positive patch test to a formaldehyde-releasing perservative found in topical medication.

Topics: Administration, Cutaneous; Anti-Infective Agents, Local; Anti-Inflammatory Agents; Calcitriol; Chemistry, Pharmaceutical; Clobetasol; Dermatitis, Allergic Contact; Dermatologic Agents; Double-Blind Method; Formaldehyde; Glucocorticoids; Humans; Keratolytic Agents; Methenamine; Patch Tests; Preservatives, Pharmaceutical; Tretinoin; Urea

Corticosteroids and vitamin D3 analogues inhibit proliferation, enhance normal keratinisation and interfere with cutaneous inflammation in in vitro systems. Both treatments are effective in psoriasis, although several reports suggest that vitamin D3 is less effective in reducing the inflammatory changes compared to its potent effect on keratinocyte growth and differentiation. The aim of the present study was to compare and contrast the effects of the vitamin D3 analogue calcipotriol, clobetasol-17-propionate and a placebo on immunohistochemical markers for epidermal growth, keratinisation and inflammation induced by a standardised single challenge with ultraviolet B (UVB) radiation in normal human skin. Clobetasol proved to inhibit UVB-induced proliferation of epidermal cells, tenascin induction, keratin 16 induction and the accumulation of T lymphocytes and CD1a-positive cells. Epidermal thinning due to clobetasol was also observed. No effect of clobetasol was shown on the enhanced terminal differentiation following UVB challenge. In contrast, calcipotriol reduced the member of transglutaminase-positive cells following UVB challenge but increased the thickness of the epidermis without a significant effect on other markers for keratinisation, epidermal proliferation and inflammation. The present study reconfirms the potent effect of topical corticosteroids on various aspects of UVB-challenged skin. In contrast, calcipotriol interfered especially with one differentiation pathway (transglutaminase) without modulation of other UVB-induced changes.

Topics: Administration, Topical; Adult; Anti-Inflammatory Agents; Calcitriol; Cell Differentiation; Cell Division; Clobetasol; Dermatologic Agents; Erythema; Glucocorticoids; Humans; Immunohistochemistry; Ki-67 Antigen; Male; Ointments; Radiodermatitis; Regression Analysis; Skin; Ultraviolet Rays