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among other factors&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">16&#8211;18</span></a> The Cal&#47;BD aerosol foam contains 2 well known active ingredients combined with volatile propellants &#40;butane and dimethyl ether&#41;&#46; The propellants evaporate soon after the product is applied&#44; leaving a thin layer of foam consisting of a supersaturated solution of Cal&#47;BD&#46; Because both active compounds are available at high concentrations&#44; they penetrate the stratum corneum more rapidly&#44; in accordance with Fick&#39;s law &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">17&#8211;23</span></a> The process involves dissolving the drugs in volatile cosolvents to allow the active ingredients to remain in the vehicle at levels that exceed the maximum solubility without precipitating&#46; Two studies&#8212;one in vitro and the other a phase I trial&#8212;have demonstrated&#44; respectively&#44; that vasoconstrictor potency and rate of penetration are superior with foam application compared to the same combination of ingredients in creams or ointments&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">20&#44;23</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Efficacy of the Cal&#47;BP Foam Formulation</span><p id="par0040" class="elsevierStylePara elsevierViewall">A first exploratory study showed that a Cal&#47;BD foam reduced the total clinical score &#40;a composite of erythema&#44; scaling&#44; and thickness&#41; significantly more than a Cal&#47;BD ointment &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;038&#41;&#44; a foam containing BD alone &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;005&#41;&#44; or the foam vehicle alone &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">22</span></a> Ultrasound measurements confirmed greater reduction of the thickening and inflammation associated with psoriasis in that study&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Further clinical trials have also demonstrated that the Cal&#47;BD foam formulation performed better than the ingredients alone in foam&#44; the Cal&#47;BD ointment or gel&#44; or the vehicle alone<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">14&#44;24&#8211;28</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">More patients &#40;45&#37;&#41; using the Cal&#47;BD foam had clear or nearly clear skin &#40;physician&#39;s global assessment &#91;PGA&#93;&#44; 0&#47;1&#41; and had also improved at least 2 points in the PGA score after 4 weeks than patients using a Cal-only foam &#40;14&#46;9&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; or a BD-only foam &#40;30&#46;7&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;047&#41; in a phase-II trial&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">21</span></a> The reduction in the modified PASI &#40;mPASI&#41; and the proportion of patients with mPASI75 improvement were also greater with the Cal&#47;BD foam &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; in another trial&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">14</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">A phase-II trial comparing the Cal&#47;BD combination in foam or ointment found that more patients had a successful response &#40;PGA&#44; 0&#47;1&#41; to the foam &#40;54&#46;6&#37;&#41; than to the ointment &#40;43&#37;&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; or to a placebo ointment or foam&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">25</span></a> The formulations had similar safety profiles&#46; The mPASI reduction was significantly greater with the foam formulation from the first week &#40;&#8722;43&#46;4&#37; vs &#8722;30&#46;5&#37; for the ointment&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; through the fourth week &#40;&#8722;74&#46;2&#37; vs &#8722;63&#46;2&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The phase III PSO-FAST trial<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a> confirmed the efficacy of the Cal&#47;BD foam&#44; reporting a success rate of 53&#46;3&#37; in the active-treatment arm &#40;vs 4&#46;8&#37; in the vehicle arm&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and a final mPASI of 2 after 4 weeks &#40;vs 5&#46;5&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Rapid and significant reduction in pruritus was reported by 83&#46;5&#37; of patients in the intervention arm&#44; and their quality of life also improved&#46; The Dermatology Life Quality Index &#40;DLQI&#41; rose 7 points with treatment but only 4&#46;4 points with the vehicle &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; and 48&#46;1&#37; of the intervention patients reported little or no effect of the disease on their quality of life &#40;DLQI&#44; 0&#47;1&#41; after 4 weeks &#40;vs 21&#46;2&#37; of vehicle patients&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">29</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The PSO-ABLE study found that Cal&#47;BD foam application was more effective at 4<span class="elsevierStyleHsp" style=""></span>weeks than the Cal&#47;BD gel at 8<span class="elsevierStyleHsp" style=""></span>weeks&#44; in terms of both the therapeutic success rates &#40;38&#37; vs 22&#37;&#44; respectively&#41; and the proportion of patients who reached mPASI75 &#40;52&#37; vs 35&#37;&#41; and mPASI90 &#40;22&#46;2 vs 10&#46;7&#37;&#41; with respecto to baseline values &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#44; all comparisons&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a> The 12-week success rates were 44&#46;1&#37; for the Cal&#47;BD foam and 34&#46;3&#37; for the gel&#46; A patient preference survey showed that 83&#46;7&#37; preferred the Cal&#47;BD foam to other therapies they had tried and that they perceived it to be more effective &#40;88&#46;3&#37;&#41;&#44; easier to apply &#40;76&#46;5&#37;&#41;&#44; and easier to tolerate &#40;81&#46;0&#37;&#41;&#46; A subsequent subanalysis of the dataset for patients with moderate to severe psoriasis &#40;10&#37; or more of body surface area involvement and&#47;or PASI or DLQI<span class="elsevierStyleHsp" style=""></span>more than<span class="elsevierStyleHsp" style=""></span>10&#41; showed that more patients improved &#40;mPASI75&#41; at 4&#44; 8&#44; and 12<span class="elsevierStyleHsp" style=""></span>weeks on the Cal&#47;BD foam than on the gel &#40;57&#46;1&#37; vs 35&#46;4&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;006 at week 12&#41;&#46; The rate of therapeutic success&#44; reflected by PGA 0&#47;1&#44; was higher for Cal&#47;BD foam only at week 8&#46; PGA 0&#47;1 response rates were as follows&#58; week 4&#44; 32&#37; vs 19&#37;&#59; week 8&#44; 35&#46;6&#37; vs 16&#46;9&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#44; and week 12&#44; 38&#37; vs 31&#46;6&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a> Another subanalysis of tpatients with the most severe disease in the dataset found that at week 12 there were reductions in proinflammatory markers &#40;interleukin 17A and macrophage-derived chemokine CCL22&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41; and that levels of adiponectin&#44; a marker with cardioprotective effects&#44; increased &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;03&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">31</span></a> Prospective placebo-controlled trials are needed to confirm these results&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Safety of Cal&#47;BD Foam</span><p id="par0070" class="elsevierStylePara elsevierViewall">Cal&#47;BD foam has been shown to have low irritative and sensitizing potential&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a> Phase II and III efficacy studies have demonstrated an acceptable safety profile and good tolerability in treatments lasting up to 12 weeks&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">14&#44;25&#8211;27</span></a> A pooled analysis of data from 3 clinical trials enrolling a total of 1104 patients treated for 4 weeks showed that the most common adverse events among users of the Cal&#47;BD foam were nasopharyngitis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#59; 1&#46;1&#37;&#41; and pain at the site of application &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#59; 0&#46;7&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">33</span></a> The rate of adverse drug reactions was 2&#46;7&#37;&#46; The most common ones were pain &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#59; 0&#46;7&#37;&#41; and puritis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#59; 0&#46;4&#37;&#41; at the site of application&#46; The overall safety profile of the Cal&#47;BD foam was similar to the profiles of the gel and ointment formulations&#46; No local or systemic adverse effects after long-term use of the foam were detected in the PSO-ABLE study&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Finally&#44; the phase II Maximum Use and Systemic Exposure &#40;MUSE&#41; study assessed the function of the hypothalamic&#8211;pituitary&#8211;adrenal &#40;HPA&#41; axis and calcium homeostasis at maximum doses of the Cal&#47;BD foam &#40;13&#46;5&#8211;113<span class="elsevierStyleHsp" style=""></span>g&#47;wk&#41; for 4<span class="elsevierStyleHsp" style=""></span>weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">34</span></a> No clinically important effects on the HPA axis&#44; albumin-corrected serum calcium level&#44; or the 24-hour urinary calcium&#8211;creatinine ratio were detected&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Topical treatments continue to be cornerstones of day-to-day management of psoriasis&#44; particularly in mild cases or as a complement to systemic treatment&#46; The main advantages of topical formulations are the reduced risk of toxicity and the better support for patient independence in disease management&#46; One disadvantage is lower efficacy in comparison with systemic treatments&#8212;although no clinical trials comparing the two have been done&#46; Another disadvantage is the possibility of lower adherence to therapy&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Developing new topical formulations that are more effective and convenient for psoriasis patients is a high-priority goal&#46; One current direction of innovation is the reformulation of known drugs<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">15</span></a> to enhance product efficacy by improving the bioavailability of active ingredients applied to the skin&#46; Reformulation also targets improved organoleptic properties&#46; Both these factors have an impact on patient preferences and increase adherence&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">This review has evaluated information related to the clinical development of the Cal&#47;BD combination in a new foam vehicle and aerosol applicator&#46; Studies demonstrate that efficacy is adequate and superior to that of existing gel and ointment forms&#44; encouraging acceptance during long-term use&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">These improvements result from the creation of a supersaturated steady-state and entirely bioavailable solution of Cal&#47;BD after the foam is applied to the skin&#46; The formulation thus has a faster rate of penetration of the stratum corneum without compromising safety&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Additional clinical trials are under way&#46; One is assessing the long-term effects of Cal&#47;BD foam for maintenance therapy &#40;NCT0289962&#41; and another is evaluating efficacy in children &#40;NCT02387853&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">35</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Several topical treatments for psoriasis are presently under development&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a> The anti-inflammatory agent cisaborole&#8212;a phosphodiesterase-4 inhibitor approved by the US Food and Drug Administration for treating atopic dermatitis&#8212;is in phase II studies for use in psoriasis &#40;NCT01300052&#41;&#46; Others are PH-10 &#40;rose Bengal disodium&#41; in a hydrogel &#40;NCT01247818&#41; and SNA-120 &#40;pegcantratinib&#41; and tofacitinib in ointment formulations &#40;NCT03322137 and NCT01831466&#44; respectively&#41;&#46; Three formulations are in phase III studies&#58; IDP-118&#44; a combination of halobetasol propionate and tazarotene in lotion &#40;NCT02462083&#41;&#59; M518101 &#40;NCT01908595&#41;&#59; and MC2-01&#44; a Cal&#47;BP combination in cream &#40;NCT03308799&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of Interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">This paper was drafted with the help of BlueBliss&#44; with funding from LEO Pharma&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Dr Puig has received consultancy and speaker&#39;s honoraria from LEO Pharma&#46; His hospital has also received funding from LEO Pharma for research in clinical trials&#46; Dr Carretero has served as a consultant or given talks for LEO Pharma and Gebro Pharma&#46;</p></span></span>"
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          "titulo" => "Innovations in Approaches to Topical Treatment of Psoriasis&#58; The Contributions of Cal&#47;BD Foam"
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              "identificador" => "sec0015"
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            1 => "Topical treatment"
            2 => "Calcipotriol"
            3 => "Betamethasone dipropionate"
            4 => "Aerosol foam"
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            0 => "Psoriasis"
            1 => "Tratamiento t&#243;pico"
            2 => "Calcipotriol"
            3 => "Dipropionato de betametasona"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Topical agents are the first-line treatment for mild and moderate psoriasis&#44; but factors such as frequency of administration&#44; organoleptic properties&#44; and the limited short term results can reduce treatment adherence and effectiveness&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Innovations in topical treatments are linked not only to the discovery of new molecules&#44; but also to the reformulation of existing active ingredients based on improvements to administration&#44; organoleptic properties&#44; bioavailability&#44; and ease of use&#46; Calcipotriol and betamethasone dipropionate aerosol foam is a new formulation in which the active ingredients are dissolved in a mixture of volatile propellants that evaporate quickly&#44; leaving a supersaturated solution of calcipotriol and betamethasone dipropionate that enhances penetration into the epidermis&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In this article&#44; we take a look at the new calcipotriol and betamethasone dipropionate aerosol formulation and briefly review the main evidence supporting the use of topical treatments for psoriasis&#46;</p></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los agentes t&#243;picos representan la primera l&#237;nea de tratamiento para la psoriasis leve y moderada&#46; Sin embargo&#44; factores como la frecuencia de administraci&#243;n&#44; las caracter&#237;sticas organol&#233;pticas o los resultados limitados a corto plazo pueden disminuir la adherencia al tratamiento y su efectividad&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Las innovaciones en los tratamientos t&#243;picos se basan en descubrir nuevas mol&#233;culas&#44; pero tambi&#233;n en la reformulaci&#243;n de principios activos ya conocidos&#44; mejorando su administraci&#243;n&#44; caracter&#237;sticas organol&#233;pticas&#44; biodisponibilidad y comodidad de uso&#46; La espuma en aerosol de calcipotriol y dipropionato de betametasona es una nueva formulaci&#243;n donde los principios activos est&#225;n disueltos en una mezcla de propelentes vol&#225;tiles que se evaporan r&#225;pidamente dejando una soluci&#243;n sobresaturada de calcipotriol y dipropionato de betametasona&#44; que aumenta la penetraci&#243;n de los f&#225;rmacos en la epidermis&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En este art&#237;culo se hace un breve repaso de las principales evidencias sobre los tratamientos t&#243;picos disponibles para la psoriasis y de la nueva formulaci&#243;n en espuma de calcipotriol y dipropionato de betametasona&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Puig L&#44; Carretero G&#46; Actualizaci&#243;n del tratamiento t&#243;pico en psoriasis&#58; aportaci&#243;n de la combinaci&#243;n de calcipotriol y dipropionato de betametasona en espuma&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;115&#8211;123&#46;</p>"
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Fick&#39;s law model of the passage of substances through membranes&#44; showing the diffusion&#8211;concentration relationship&#46; The law postulates that substances flow from an area of high concentration to areas of low concentration to a degree that is proportional to the concentration gradient&#46; This is to say&#44; the higher the concentration&#44; the higher the diffusion of the drug through the membrane&#44; and by analogy&#44; of the active ingredient through the epidermis&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; Cal&#47;BD&#44; calcipotriol plus betamethasone dipropionate&#59; IGA&#44; investigator&#39;s global assessment of overall improvement&#59; TSS&#44; total severity score&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mechanism of Action&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Efficacy vs Placebo<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Efficacy vs Other Options&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recommendations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Drawbacks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Highly potent topical corticosteroids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Anti-inflammatory and immunomodulatory&#58; modulate genetic transcription of anti-inflammatory molecules and &#8595;proinflammatory cytokines<br>Nongenic effects on dermal fibroblasts and vessels</td><td class="td" title="table-entry  " align="left" valign="top">Meta-analysis&#58; 10 studies &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1264&#41;<br>Effect size &#40;95&#37; CI&#41;&#58; &#8722;1&#46;56<br>IGA score&#58; 1&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>Potent corticosteroids<br>&#60;<span class="elsevierStyleHsp" style=""></span>Corticosteroid<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>vitamin D analog<br>&#62;<span class="elsevierStyleHsp" style=""></span>Vitamin D analogs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not for use on skin folds or face&#46;<br>Body<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>scalp psoriasis<br>Dose&#58; 1 application&#47;d<br>Short term&#58; 4 wk<br>Intermittent long-term regimen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rebound effect<br>Tachyphylaxis<br>Skin atrophy<br>Striae<br>Telangiectasia<br>Possible systemic effects&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Potent topical corticosteroids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Meta-analysis&#58; 13 studies &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2216&#41;<br>Effect size &#40;95&#37; CI&#41;&#58; &#8722;0&#46;89<br>IGA score&#58; 1&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>Highly potent corticosteroids<br>&#60;<span class="elsevierStyleHsp" style=""></span>Corticosteroid<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>vitamin D analogs<br>&#60;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Vitamin D analogs<br>&#62;<span class="elsevierStyleHsp" style=""></span>Vitamin D analogs on scalp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vitamin D analogs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Effect on genetic transcription&#44; keratinocytes&#58;<br>&#8595;cell hyperproliferation&#44;<br>&#8593;cell differentiation&#44;<br>&#8595;production of proinflammatory cytokines&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Meta-analysis&#58; 30 studies &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4986&#41;<br>Effect size &#40;95&#37; CI&#41;&#58; &#8722;0&#46;90<br>IGA score&#58; 1&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>Highly potent corticosteroids<br>&#60;<span class="elsevierStyleHsp" style=""></span>Corticosteroid<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>vitamin D analogs<br>&#60;<span class="elsevierStyleHsp" style=""></span>Potent or highly potent corticosteroids on scalp<br>&#60;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Potent corticosteroids<br>&#60;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Dithranol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Body psoriasis<br>Dose&#58; 1 or 2 times&#47;d<br>Duration&#58; no limit<br>Not in children under 6 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Skin irritation&#58; pain and itching at site of application&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Combined corticosteroid<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>vitamin D analog &#40;Cal&#47;BD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complementary anti-inflammatory and immunomodulatory effects&#58; &#8593;rapid onset&#44; &#8593;enduring posttreatment effect&#44; &#8595;rebound effect&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Meta-analysis&#58; 5 studies &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2058&#41;<br>Effect size &#40;95&#37; CI&#41;&#58; &#8722;1&#46;44<br>IGA score&#58; 2&#46;18 &#40;2 times&#47;d&#41;&#44; 1&#46;39 &#40;1 time&#47;d&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>Highly potent corticosteroids<br>&#60;<span class="elsevierStyleHsp" style=""></span>Potent or highly potent corticosteroids on scalp<br>&#62;<span class="elsevierStyleHsp" style=""></span>Potent corticosteroids<br>&#62;<span class="elsevierStyleHsp" style=""></span>Vitamin D analogs<br>&#62;<span class="elsevierStyleHsp" style=""></span>Dithranol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Body<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>scalp psoriasis<br>Dose&#58; 1 or 2 times&#47;d<br>Fixed combination or separately<br>Duration&#58; no limit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AE &#40;fewer than if separate&#41;&#58; pain and itching on site of application&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dithranol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8595;hyperproliferation of keratinocytes&#44;<br>&#8595;granulocytic function<br>Immunosuppressant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Meta-analysis&#58; 3 studies &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>47&#41;<br>Effect size &#40;95&#37; CI&#41;&#58; &#8722;1&#46;06<br>IGA score&#58; 1&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>Highly potent corticosteroids<br>&#60;<span class="elsevierStyleHsp" style=""></span>Potent corticosteroids &#60;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Vitamin D analogs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Best in combined therapy &#40;corticosteroids&#44; vitamin D analogs&#44; phototherapy&#41;<br>Dose&#58; 1&#8211;2 times&#47;d<br>For use in specialist clinics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Local irritation<br>Staining &#40;clothing&#44; furnishings&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tazarotene&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Regulates proliferation and differentiation of keratinocytes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Meta-analysis&#58; 1 study &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>318&#41;<br>Effect size &#40;95&#37; CI&#41;&#58; &#8722;0&#46;86<br>TSS&#58; 3&#46;8 vs 5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>Highly potent corticosteroids<br>&#60;<span class="elsevierStyleHsp" style=""></span>Potent corticosteroids<br>&#60;<span class="elsevierStyleHsp" style=""></span>Vitamin D analogs<br>&#60;<span class="elsevierStyleHsp" style=""></span>Dithranol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gel formulation<br>Long-lasting effect after treatment<br>Dose 1 time&#47;day<br>Combined with corticosteroids<br>Indication&#58; soles&#44; palms&#44; nails&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Low efficacy<br>Local irritation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Information adapted from Mason et al and Samarasekera et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">6&#44;7</span></a></p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Summary of the Main Properties of Topical Psoriasis Treatments</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ACTH&#44; adrenocorticotropic hormone&#59; AE&#44; adverse events&#59; BSA&#44; body surface area&#59; mPASI&#44; Psoriasis Area and Severity Index modified by ignoring psoriasis on the head&#59; ADR&#44; adverse drug reaction&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study Design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of Subjects&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dose Regimen and Duration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Pharmacokinetics and bioavailability</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Penetration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hollesen Basse et al&#46; <span class="elsevierStyleItalic">J Invest Dermatol&#46;2014</span><span class="elsevierStyleItalic">&#40;ref&#46;20&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">In vitro&#44; phase I&#44; pig ear skin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam vs Cal&#47;BD ointment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Single application<br>Controls at 2<span class="elsevierStyleHsp" style=""></span>h&#44; 6<span class="elsevierStyleHsp" style=""></span>h&#44; 21<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Greater penetration of foam vs ointment &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;<br>Stability&#58; foam levels constant&#44; 2&#8211;21<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vasoconstrictor potency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Queille-Roussel et al&#46; <span class="elsevierStyleItalic">J Eur Acad Dermatol Venereol&#46;</span><span class="elsevierStyleItalic">2016</span><span class="elsevierStyleItalic">&#40;ref&#46;23&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phase I&#44; single-center&#44; researcher-blinded&#44; controlled&#44; intraindividual comparisons&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 healthy volunteers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs Cal&#47;BD ointment<br>vs clobetasol cream<br>vs fluocinolone ointment<br>vs BD foam<br>vs foam vehicle<br>vs negative control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Single application at different locations&#44;<br>6&#8211;32<span class="elsevierStyleHsp" style=""></span>h postapplication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vasoconstrictor potency&#58; clobetasol cream<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Cal&#47;BD<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>fluocinolone ointment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Efficacy</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Exploratory study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Queille-Roussel et al&#46;<span class="elsevierStyleItalic">Clin Drug Investig&#46;2015 &#40;ref&#46;22&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phase IIa&#44; exploratory&#44; single-center&#44; researcher-blinded&#44; controlled<br>Intraindividual comparisons&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs Cal&#47;BD ointment<br>vs BD foam<br>vs foam vehicle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d&#44; 4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Total clinical score&#58;<br>Cal&#47;BD foam&#58; &#8722;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;27<br>vs Cal&#47;BD ointment&#58; &#8722;5&#46;25 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;<br>vs BD foam &#8722;4&#46;96 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;<br>vs foam vehicle &#8722;1&#46;88 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vs single active components&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lebwohl et al&#46; <span class="elsevierStyleItalic">J Clin Aesthet Dermatol&#46; 2016 &#40;ref&#46;14&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phase II&#44; multicenter&#44; randomized&#44; double-blind&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">302 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs Cal foam<br>vs BD foam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d&#44; 4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Success rate&#47;mPASI75 &#40;4 wk&#41;&#58;<br>Cal&#47;BD foam&#44; 45&#37;&#47;49&#37;<br>vs Cal foam&#44; 14&#46;9&#37;&#47;18&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>vs BD foam&#44; 30&#46;7&#37;&#47;34&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vs Cal&#47;BD ointment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Koo et al&#46; <span class="elsevierStyleItalic">J Dermatolog Treat&#46; 2016 &#40;ref&#46;25&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phase II&#44; multicenter&#44; randomized&#44; researcher-blinded&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">376 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs Cal&#47;BD ointment<br>vs foam vehicle<br>vs ointment vehicle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d&#44; 4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Success rate&#47;&#8595;mPASI &#40;4 wk&#41;&#58;<br>Cal&#47;BD foam&#44; 54&#46;6&#37;&#47;&#8595;74&#46;2&#37;<br>vs Cal&#47;BD ointment 43&#37;&#47;&#8595;63&#46;2&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vs vehicle<br>PSO-FAST study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Leonardi et al&#46; <span class="elsevierStyleItalic">J Drugs Dermatol&#46; 2015 &#40;ref&#46;26&#41;</span>&#59;<br><span class="elsevierStyleItalic">J Drugs Dermatol&#46; 2016 &#40;ref&#46;29&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phase III&#44; multicenter&#44; randomized&#44; double-blind&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">426 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs foam vehicle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d&#44; 4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Results &#40;wk 4&#41;<br>Success&#58; 53&#46;3&#37; vs 4&#46;8&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>mPASI&#58; 2 vs 5&#46;5 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>mPAS75&#58; 52&#46;9&#37; vs 8&#46;2&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>&#8595;70&#37; pruritus&#58; 83&#46;5&#37; vs 40&#46;6&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>DLQI &#40;0&#47;1&#41;&#58; 48&#46;1&#37; vs 21&#46;2&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vs Cal&#47;BD gel&#44;<br>PSO-ABLE study</td><td class="td" title="table-entry  " align="left" valign="top">Paul et al&#46; <span class="elsevierStyleItalic">J Eur Acad Dermatol Venereol&#46;</span><span class="elsevierStyleItalic">2017 &#40;ref&#46;27&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phase III&#44; multicenter&#44; randomized&#44; researcher-blinded&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">463 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs Cal&#47;BD gel<br>vs foam vehicle<br>vs gel vehicle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d&#44; 12 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Results &#40;4 wk vs 8 wk&#41;<br>Success&#58; 38&#37; vs 22&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>mPASI75&#58; 52&#37; vs 35&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>mPASI90&#58; 22&#37; vs 11&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>Success &#40;12 wk&#41;&#58; 44&#37; vs 34&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Paul et al&#46; <span class="elsevierStyleItalic">Am J Clin Dermatol&#46; 2017 &#40;ref&#46;30&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PSO-ABLE subgroup analysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">159 patients&#44; moderate to severe psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>77&#41;<br>vs Cal&#47;BD &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d&#44; 12 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Success &#40;4 wk&#41;&#58; 32&#37; vs 19&#37;<br>Success &#40;4 wk&#41;&#58; 36&#37; vs 17&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;<br>Success &#40;12 wk&#41;&#58; 38&#37; vs 32&#37;<br>mPASI75 &#40;4 wk 4&#41;&#58; 40&#37; vs 17&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>mPASI75 &#40;8 wk&#41;&#58; 53&#37; vs 22&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>mPASI75 &#40;12 wk&#41;&#58; 57&#37; vs 35&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pooled data analysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Stein Gold et al&#46; <span class="elsevierStyleItalic">J Drugs Dermatol&#46; 2016 &#40;ref&#46;28&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pooled-data analysis of<br>Koo et al <span class="elsevierStyleItalic">&#40;ref&#46;25&#41;</span> &#43; Lebwohl et al <span class="elsevierStyleItalic">&#40;ref&#46;14&#41;</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><br>Leonardi et al <span class="elsevierStyleItalic">&#40;ref&#46;26&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1104 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs Cal foam<br>vs BD foam<br>vs Cal&#47;BD ointment<br>vs foam vehicle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d&#44; 4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Success rate&#47;&#8595; mPASI&#47;PASI75 &#40;4 wk&#41;&#58;<br>Cal&#47;BD foam&#44; 51&#37;&#47;&#8595;72&#37;&#47;51&#37;<br>vs Cal&#47;BD ointment&#44; 43&#37;&#47;&#8595;63&#37;&#47;41&#37;<br>vs BD foam&#44; 31&#37;&#47;&#8595;53&#37;&#47;34&#37;<br>vs Cal foam&#44; 15&#37;&#47;&#8595;43&#37;&#47;18&#37;<br>vs vehicle foam&#44; 5&#37;&#47;&#8595;32&#37;&#47;7&#37;<br>vs vehicle ointment&#44; 8&#37;&#47;&#8595;33&#37;&#47;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Safety</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tolerability data from efficacy trials&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Menter et al&#46; <span class="elsevierStyleItalic">Skinmed 2017</span><span class="elsevierStyleItalic">&#40;ref&#46;33&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pooled-data analysis of<br>Koo et al <span class="elsevierStyleItalic">&#40;ref&#46;25&#41;</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Lebwohl et al <span class="elsevierStyleItalic">&#40;ref&#46;14&#41;</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><br>Leonardi et al <span class="elsevierStyleItalic">&#40;ref&#46;26&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1104 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs Cal foam<br>vs BD foam<br>vs Cal&#47;BD ointment<br>vs foam vehicle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d&#44; 12 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AE&#58; Cal&#47;BD foam&#44; 13&#46;8&#37; &#40;NS vs others&#41;<br>ADR&#58; Cal&#47;BD foam 2&#46;7&#37;<br>vs 3&#37; Cal&#47;BD ointment<br>vs 6&#46;1&#37; Cal foam<br>vs 7&#46;1&#37; BD foam<br>Most common ADR to Cal&#47;BD foam&#58; pain &#40;4&#47;564&#41; and pruritus &#40;2&#47;564&#41; at application site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Potential for irritation and sensitization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Queille-Roussel et al&#46; <span class="elsevierStyleItalic">J Am Acad Dermatol&#46; 2015 &#40;ref&#46;32&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phase I&#44; single center&#44; randomized&#44; controlled&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">213 healthy volunteers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs foam vehicle<br>vs white petroleum jelly &#40;negative control&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 applications&#47;wk &#40;semiocclusive patches&#41; for 3 wk<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>2 wk rest<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1 application&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Low irritative potential<br>Maximum score&#44; 2 &#40;erythema with mild to moderate edema in 3&#47;213 volunteers&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MUSE &#40;Maximum Use and Systemic Exposure&#41; trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Taraska et al&#46; <span class="elsevierStyleItalic">J Cutan Med Surg&#46; 2016 &#40;ref&#46;34&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phase II&#44; multicenter&#44; open-label&#44; uncontrolled&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 patients&#44; moderate to severe psoriasis BSA&#58; 15&#37;&#8211;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d<br>4 wk<br>13&#46;5&#8211;113<span class="elsevierStyleHsp" style=""></span>g&#47;wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ACTH challenge test&#58; normal<br>Albumin-corrected calcium level<br>&#58; normal<br>24-h urinary calcium&#58; normal<br>Calcium&#8211; creatinine ratio in urine&#58; normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                    0 => array:2 [
                      "titulo" => "Prevalence of psoriasis in Spain in the age of biologics"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Ferr&#225;ndiz"
                            1 => "J&#46;M&#46; Carrascosa"
                            2 => "M&#46; Toro"
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                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2013.12.008"
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                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2014"
                        "volumen" => "105"
                        "paginaInicial" => "504"
                        "paginaFinal" => "509"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24569109"
                            "web" => "Medline"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Efficacy of biologics in the treatment of moderate-to-severe plaque psoriasis&#58; A systematic review and meta-analysis of randomized controlled trials with different time points"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Puig"
                            1 => "A&#46; L&#243;pez"
                            2 => "E&#46; Vilarrasa"
                            3 => "I&#46; Garc&#237;a"
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                    0 => array:2 [
                      "doi" => "10.1111/jdv.12238"
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                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
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                        "volumen" => "28"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24033851"
                            "web" => "Medline"
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                    0 => array:2 [
                      "titulo" => "Predictors of biologic treatment of psoriasis&#58; A non-interventional study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Puig"
                            1 => "T&#46; Fan"
                            2 => "Q&#46; Ding"
                            3 => "N&#46;E&#46; Smith"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2147/CEOR.S54797"
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Novelties in Dermatology
Update on Topical Treatments for Psoriasis: The Role of Calcipotriol Plus Betamethasone Dipropionate Aerosol Foam
Actualización del tratamiento tópico en psoriasis: aportación de la combinación de calcipotriol y dipropionato de betametasona en espuma
L. Puiga,
Autor para correspondencia
lpuig@santpau.cat

Corresponding author.
, G. Carreterob
a Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
b Servicio de Dermatología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España
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using the Cal&#47;BD foam had clear or nearly clear skin &#40;physician&#39;s global assessment &#91;PGA&#93;&#44; 0&#47;1&#41; and had also improved at least 2 points in the PGA score after 4 weeks than patients using a Cal-only foam &#40;14&#46;9&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; or a BD-only foam &#40;30&#46;7&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;047&#41; in a phase-II trial&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">21</span></a> The reduction in the modified PASI &#40;mPASI&#41; and the proportion of patients with mPASI75 improvement were also greater with the Cal&#47;BD foam &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; in another trial&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">14</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">A phase-II trial comparing the Cal&#47;BD combination in foam or ointment found that more patients had a successful response &#40;PGA&#44; 0&#47;1&#41; to the foam &#40;54&#46;6&#37;&#41; than to the ointment &#40;43&#37;&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41; or to a placebo ointment or foam&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">25</span></a> The formulations had similar safety profiles&#46; The mPASI reduction was significantly greater with the foam formulation from the first week &#40;&#8722;43&#46;4&#37; vs &#8722;30&#46;5&#37; for the ointment&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; through the fourth week &#40;&#8722;74&#46;2&#37; vs &#8722;63&#46;2&#37;&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The phase III PSO-FAST trial<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a> confirmed the efficacy of the Cal&#47;BD foam&#44; reporting a success rate of 53&#46;3&#37; in the active-treatment arm &#40;vs 4&#46;8&#37; in the vehicle arm&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and a final mPASI of 2 after 4 weeks &#40;vs 5&#46;5&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Rapid and significant reduction in pruritus was reported by 83&#46;5&#37; of patients in the intervention arm&#44; and their quality of life also improved&#46; The Dermatology Life Quality Index &#40;DLQI&#41; rose 7 points with treatment but only 4&#46;4 points with the vehicle &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; and 48&#46;1&#37; of the intervention patients reported little or no effect of the disease on their quality of life &#40;DLQI&#44; 0&#47;1&#41; after 4 weeks &#40;vs 21&#46;2&#37; of vehicle patients&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">29</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The PSO-ABLE study found that Cal&#47;BD foam application was more effective at 4<span class="elsevierStyleHsp" style=""></span>weeks than the Cal&#47;BD gel at 8<span class="elsevierStyleHsp" style=""></span>weeks&#44; in terms of both the therapeutic success rates &#40;38&#37; vs 22&#37;&#44; respectively&#41; and the proportion of patients who reached mPASI75 &#40;52&#37; vs 35&#37;&#41; and mPASI90 &#40;22&#46;2 vs 10&#46;7&#37;&#41; with respecto to baseline values &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#44; all comparisons&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a> The 12-week success rates were 44&#46;1&#37; for the Cal&#47;BD foam and 34&#46;3&#37; for the gel&#46; A patient preference survey showed that 83&#46;7&#37; preferred the Cal&#47;BD foam to other therapies they had tried and that they perceived it to be more effective &#40;88&#46;3&#37;&#41;&#44; easier to apply &#40;76&#46;5&#37;&#41;&#44; and easier to tolerate &#40;81&#46;0&#37;&#41;&#46; A subsequent subanalysis of the dataset for patients with moderate to severe psoriasis &#40;10&#37; or more of body surface area involvement and&#47;or PASI or DLQI<span class="elsevierStyleHsp" style=""></span>more than<span class="elsevierStyleHsp" style=""></span>10&#41; showed that more patients improved &#40;mPASI75&#41; at 4&#44; 8&#44; and 12<span class="elsevierStyleHsp" style=""></span>weeks on the Cal&#47;BD foam than on the gel &#40;57&#46;1&#37; vs 35&#46;4&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;006 at week 12&#41;&#46; The rate of therapeutic success&#44; reflected by PGA 0&#47;1&#44; was higher for Cal&#47;BD foam only at week 8&#46; PGA 0&#47;1 response rates were as follows&#58; week 4&#44; 32&#37; vs 19&#37;&#59; week 8&#44; 35&#46;6&#37; vs 16&#46;9&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#44; and week 12&#44; 38&#37; vs 31&#46;6&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">30</span></a> Another subanalysis of tpatients with the most severe disease in the dataset found that at week 12 there were reductions in proinflammatory markers &#40;interleukin 17A and macrophage-derived chemokine CCL22&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41; and that levels of adiponectin&#44; a marker with cardioprotective effects&#44; increased &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;03&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">31</span></a> Prospective placebo-controlled trials are needed to confirm these results&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Safety of Cal&#47;BD Foam</span><p id="par0070" class="elsevierStylePara elsevierViewall">Cal&#47;BD foam has been shown to have low irritative and sensitizing potential&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a> Phase II and III efficacy studies have demonstrated an acceptable safety profile and good tolerability in treatments lasting up to 12 weeks&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">14&#44;25&#8211;27</span></a> A pooled analysis of data from 3 clinical trials enrolling a total of 1104 patients treated for 4 weeks showed that the most common adverse events among users of the Cal&#47;BD foam were nasopharyngitis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#59; 1&#46;1&#37;&#41; and pain at the site of application &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#59; 0&#46;7&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">33</span></a> The rate of adverse drug reactions was 2&#46;7&#37;&#46; The most common ones were pain &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#59; 0&#46;7&#37;&#41; and puritis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#59; 0&#46;4&#37;&#41; at the site of application&#46; The overall safety profile of the Cal&#47;BD foam was similar to the profiles of the gel and ointment formulations&#46; No local or systemic adverse effects after long-term use of the foam were detected in the PSO-ABLE study&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Finally&#44; the phase II Maximum Use and Systemic Exposure &#40;MUSE&#41; study assessed the function of the hypothalamic&#8211;pituitary&#8211;adrenal &#40;HPA&#41; axis and calcium homeostasis at maximum doses of the Cal&#47;BD foam &#40;13&#46;5&#8211;113<span class="elsevierStyleHsp" style=""></span>g&#47;wk&#41; for 4<span class="elsevierStyleHsp" style=""></span>weeks&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">34</span></a> No clinically important effects on the HPA axis&#44; albumin-corrected serum calcium level&#44; or the 24-hour urinary calcium&#8211;creatinine ratio were detected&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Topical treatments continue to be cornerstones of day-to-day management of psoriasis&#44; particularly in mild cases or as a complement to systemic treatment&#46; The main advantages of topical formulations are the reduced risk of toxicity and the better support for patient independence in disease management&#46; One disadvantage is lower efficacy in comparison with systemic treatments&#8212;although no clinical trials comparing the two have been done&#46; Another disadvantage is the possibility of lower adherence to therapy&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Developing new topical formulations that are more effective and convenient for psoriasis patients is a high-priority goal&#46; One current direction of innovation is the reformulation of known drugs<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">15</span></a> to enhance product efficacy by improving the bioavailability of active ingredients applied to the skin&#46; Reformulation also targets improved organoleptic properties&#46; Both these factors have an impact on patient preferences and increase adherence&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">This review has evaluated information related to the clinical development of the Cal&#47;BD combination in a new foam vehicle and aerosol applicator&#46; Studies demonstrate that efficacy is adequate and superior to that of existing gel and ointment forms&#44; encouraging acceptance during long-term use&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">These improvements result from the creation of a supersaturated steady-state and entirely bioavailable solution of Cal&#47;BD after the foam is applied to the skin&#46; The formulation thus has a faster rate of penetration of the stratum corneum without compromising safety&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Additional clinical trials are under way&#46; One is assessing the long-term effects of Cal&#47;BD foam for maintenance therapy &#40;NCT0289962&#41; and another is evaluating efficacy in children &#40;NCT02387853&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">35</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Several topical treatments for psoriasis are presently under development&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a> The anti-inflammatory agent cisaborole&#8212;a phosphodiesterase-4 inhibitor approved by the US Food and Drug Administration for treating atopic dermatitis&#8212;is in phase II studies for use in psoriasis &#40;NCT01300052&#41;&#46; Others are PH-10 &#40;rose Bengal disodium&#41; in a hydrogel &#40;NCT01247818&#41; and SNA-120 &#40;pegcantratinib&#41; and tofacitinib in ointment formulations &#40;NCT03322137 and NCT01831466&#44; respectively&#41;&#46; Three formulations are in phase III studies&#58; IDP-118&#44; a combination of halobetasol propionate and tazarotene in lotion &#40;NCT02462083&#41;&#59; M518101 &#40;NCT01908595&#41;&#59; and MC2-01&#44; a Cal&#47;BP combination in cream &#40;NCT03308799&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflicts of Interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">This paper was drafted with the help of BlueBliss&#44; with funding from LEO Pharma&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Dr Puig has received consultancy and speaker&#39;s honoraria from LEO Pharma&#46; His hospital has also received funding from LEO Pharma for research in clinical trials&#46; Dr Carretero has served as a consultant or given talks for LEO Pharma and Gebro Pharma&#46;</p></span></span>"
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          "titulo" => "Innovations in Approaches to Topical Treatment of Psoriasis&#58; The Contributions of Cal&#47;BD Foam"
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              "identificador" => "sec0015"
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            1 => "Topical treatment"
            2 => "Calcipotriol"
            3 => "Betamethasone dipropionate"
            4 => "Aerosol foam"
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          "palabras" => array:5 [
            0 => "Psoriasis"
            1 => "Tratamiento t&#243;pico"
            2 => "Calcipotriol"
            3 => "Dipropionato de betametasona"
            4 => "Espuma en aerosol"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Topical agents are the first-line treatment for mild and moderate psoriasis&#44; but factors such as frequency of administration&#44; organoleptic properties&#44; and the limited short term results can reduce treatment adherence and effectiveness&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Innovations in topical treatments are linked not only to the discovery of new molecules&#44; but also to the reformulation of existing active ingredients based on improvements to administration&#44; organoleptic properties&#44; bioavailability&#44; and ease of use&#46; Calcipotriol and betamethasone dipropionate aerosol foam is a new formulation in which the active ingredients are dissolved in a mixture of volatile propellants that evaporate quickly&#44; leaving a supersaturated solution of calcipotriol and betamethasone dipropionate that enhances penetration into the epidermis&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">In this article&#44; we take a look at the new calcipotriol and betamethasone dipropionate aerosol formulation and briefly review the main evidence supporting the use of topical treatments for psoriasis&#46;</p></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los agentes t&#243;picos representan la primera l&#237;nea de tratamiento para la psoriasis leve y moderada&#46; Sin embargo&#44; factores como la frecuencia de administraci&#243;n&#44; las caracter&#237;sticas organol&#233;pticas o los resultados limitados a corto plazo pueden disminuir la adherencia al tratamiento y su efectividad&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Las innovaciones en los tratamientos t&#243;picos se basan en descubrir nuevas mol&#233;culas&#44; pero tambi&#233;n en la reformulaci&#243;n de principios activos ya conocidos&#44; mejorando su administraci&#243;n&#44; caracter&#237;sticas organol&#233;pticas&#44; biodisponibilidad y comodidad de uso&#46; La espuma en aerosol de calcipotriol y dipropionato de betametasona es una nueva formulaci&#243;n donde los principios activos est&#225;n disueltos en una mezcla de propelentes vol&#225;tiles que se evaporan r&#225;pidamente dejando una soluci&#243;n sobresaturada de calcipotriol y dipropionato de betametasona&#44; que aumenta la penetraci&#243;n de los f&#225;rmacos en la epidermis&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En este art&#237;culo se hace un breve repaso de las principales evidencias sobre los tratamientos t&#243;picos disponibles para la psoriasis y de la nueva formulaci&#243;n en espuma de calcipotriol y dipropionato de betametasona&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; Puig L&#44; Carretero G&#46; Actualizaci&#243;n del tratamiento t&#243;pico en psoriasis&#58; aportaci&#243;n de la combinaci&#243;n de calcipotriol y dipropionato de betametasona en espuma&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;115&#8211;123&#46;</p>"
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          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Fick&#39;s law model of the passage of substances through membranes&#44; showing the diffusion&#8211;concentration relationship&#46; The law postulates that substances flow from an area of high concentration to areas of low concentration to a degree that is proportional to the concentration gradient&#46; This is to say&#44; the higher the concentration&#44; the higher the diffusion of the drug through the membrane&#44; and by analogy&#44; of the active ingredient through the epidermis&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; Cal&#47;BD&#44; calcipotriol plus betamethasone dipropionate&#59; IGA&#44; investigator&#39;s global assessment of overall improvement&#59; TSS&#44; total severity score&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mechanism of Action&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Efficacy vs Placebo<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Efficacy vs Other Options&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recommendations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Drawbacks&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Highly potent topical corticosteroids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Anti-inflammatory and immunomodulatory&#58; modulate genetic transcription of anti-inflammatory molecules and &#8595;proinflammatory cytokines<br>Nongenic effects on dermal fibroblasts and vessels</td><td class="td" title="table-entry  " align="left" valign="top">Meta-analysis&#58; 10 studies &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1264&#41;<br>Effect size &#40;95&#37; CI&#41;&#58; &#8722;1&#46;56<br>IGA score&#58; 1&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>Potent corticosteroids<br>&#60;<span class="elsevierStyleHsp" style=""></span>Corticosteroid<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>vitamin D analog<br>&#62;<span class="elsevierStyleHsp" style=""></span>Vitamin D analogs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not for use on skin folds or face&#46;<br>Body<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>scalp psoriasis<br>Dose&#58; 1 application&#47;d<br>Short term&#58; 4 wk<br>Intermittent long-term regimen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rebound effect<br>Tachyphylaxis<br>Skin atrophy<br>Striae<br>Telangiectasia<br>Possible systemic effects&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Potent topical corticosteroids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Meta-analysis&#58; 13 studies &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2216&#41;<br>Effect size &#40;95&#37; CI&#41;&#58; &#8722;0&#46;89<br>IGA score&#58; 1&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>Highly potent corticosteroids<br>&#60;<span class="elsevierStyleHsp" style=""></span>Corticosteroid<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>vitamin D analogs<br>&#60;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Vitamin D analogs<br>&#62;<span class="elsevierStyleHsp" style=""></span>Vitamin D analogs on scalp&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Vitamin D analogs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Effect on genetic transcription&#44; keratinocytes&#58;<br>&#8595;cell hyperproliferation&#44;<br>&#8593;cell differentiation&#44;<br>&#8595;production of proinflammatory cytokines&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Meta-analysis&#58; 30 studies &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4986&#41;<br>Effect size &#40;95&#37; CI&#41;&#58; &#8722;0&#46;90<br>IGA score&#58; 1&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>Highly potent corticosteroids<br>&#60;<span class="elsevierStyleHsp" style=""></span>Corticosteroid<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>vitamin D analogs<br>&#60;<span class="elsevierStyleHsp" style=""></span>Potent or highly potent corticosteroids on scalp<br>&#60;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Potent corticosteroids<br>&#60;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Dithranol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Body psoriasis<br>Dose&#58; 1 or 2 times&#47;d<br>Duration&#58; no limit<br>Not in children under 6 y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Skin irritation&#58; pain and itching at site of application&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Combined corticosteroid<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>vitamin D analog &#40;Cal&#47;BD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Complementary anti-inflammatory and immunomodulatory effects&#58; &#8593;rapid onset&#44; &#8593;enduring posttreatment effect&#44; &#8595;rebound effect&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Meta-analysis&#58; 5 studies &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2058&#41;<br>Effect size &#40;95&#37; CI&#41;&#58; &#8722;1&#46;44<br>IGA score&#58; 2&#46;18 &#40;2 times&#47;d&#41;&#44; 1&#46;39 &#40;1 time&#47;d&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#62;<span class="elsevierStyleHsp" style=""></span>Highly potent corticosteroids<br>&#60;<span class="elsevierStyleHsp" style=""></span>Potent or highly potent corticosteroids on scalp<br>&#62;<span class="elsevierStyleHsp" style=""></span>Potent corticosteroids<br>&#62;<span class="elsevierStyleHsp" style=""></span>Vitamin D analogs<br>&#62;<span class="elsevierStyleHsp" style=""></span>Dithranol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Body<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>scalp psoriasis<br>Dose&#58; 1 or 2 times&#47;d<br>Fixed combination or separately<br>Duration&#58; no limit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AE &#40;fewer than if separate&#41;&#58; pain and itching on site of application&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dithranol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8595;hyperproliferation of keratinocytes&#44;<br>&#8595;granulocytic function<br>Immunosuppressant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Meta-analysis&#58; 3 studies &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>47&#41;<br>Effect size &#40;95&#37; CI&#41;&#58; &#8722;1&#46;06<br>IGA score&#58; 1&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>Highly potent corticosteroids<br>&#60;<span class="elsevierStyleHsp" style=""></span>Potent corticosteroids &#60;<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Vitamin D analogs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Best in combined therapy &#40;corticosteroids&#44; vitamin D analogs&#44; phototherapy&#41;<br>Dose&#58; 1&#8211;2 times&#47;d<br>For use in specialist clinics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Local irritation<br>Staining &#40;clothing&#44; furnishings&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tazarotene&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Regulates proliferation and differentiation of keratinocytes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Meta-analysis&#58; 1 study &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>318&#41;<br>Effect size &#40;95&#37; CI&#41;&#58; &#8722;0&#46;86<br>TSS&#58; 3&#46;8 vs 5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;<span class="elsevierStyleHsp" style=""></span>Highly potent corticosteroids<br>&#60;<span class="elsevierStyleHsp" style=""></span>Potent corticosteroids<br>&#60;<span class="elsevierStyleHsp" style=""></span>Vitamin D analogs<br>&#60;<span class="elsevierStyleHsp" style=""></span>Dithranol&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gel formulation<br>Long-lasting effect after treatment<br>Dose 1 time&#47;day<br>Combined with corticosteroids<br>Indication&#58; soles&#44; palms&#44; nails&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Low efficacy<br>Local irritation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Information adapted from Mason et al and Samarasekera et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">6&#44;7</span></a></p>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Summary of the Main Properties of Topical Psoriasis Treatments</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; ACTH&#44; adrenocorticotropic hormone&#59; AE&#44; adverse events&#59; BSA&#44; body surface area&#59; mPASI&#44; Psoriasis Area and Severity Index modified by ignoring psoriasis on the head&#59; ADR&#44; adverse drug reaction&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Reference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study Design&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of Subjects&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Treatments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dose Regimen and Duration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Pharmacokinetics and bioavailability</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Penetration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hollesen Basse et al&#46; <span class="elsevierStyleItalic">J Invest Dermatol&#46;2014</span><span class="elsevierStyleItalic">&#40;ref&#46;20&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">In vitro&#44; phase I&#44; pig ear skin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam vs Cal&#47;BD ointment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Single application<br>Controls at 2<span class="elsevierStyleHsp" style=""></span>h&#44; 6<span class="elsevierStyleHsp" style=""></span>h&#44; 21<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Greater penetration of foam vs ointment &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;<br>Stability&#58; foam levels constant&#44; 2&#8211;21<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vasoconstrictor potency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Queille-Roussel et al&#46; <span class="elsevierStyleItalic">J Eur Acad Dermatol Venereol&#46;</span><span class="elsevierStyleItalic">2016</span><span class="elsevierStyleItalic">&#40;ref&#46;23&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phase I&#44; single-center&#44; researcher-blinded&#44; controlled&#44; intraindividual comparisons&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 healthy volunteers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs Cal&#47;BD ointment<br>vs clobetasol cream<br>vs fluocinolone ointment<br>vs BD foam<br>vs foam vehicle<br>vs negative control&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Single application at different locations&#44;<br>6&#8211;32<span class="elsevierStyleHsp" style=""></span>h postapplication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vasoconstrictor potency&#58; clobetasol cream<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>Cal&#47;BD<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>fluocinolone ointment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Efficacy</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Exploratory study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Queille-Roussel et al&#46;<span class="elsevierStyleItalic">Clin Drug Investig&#46;2015 &#40;ref&#46;22&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phase IIa&#44; exploratory&#44; single-center&#44; researcher-blinded&#44; controlled<br>Intraindividual comparisons&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs Cal&#47;BD ointment<br>vs BD foam<br>vs foam vehicle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d&#44; 4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Total clinical score&#58;<br>Cal&#47;BD foam&#58; &#8722;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;27<br>vs Cal&#47;BD ointment&#58; &#8722;5&#46;25 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;<br>vs BD foam &#8722;4&#46;96 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;<br>vs foam vehicle &#8722;1&#46;88 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;0001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vs single active components&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lebwohl et al&#46; <span class="elsevierStyleItalic">J Clin Aesthet Dermatol&#46; 2016 &#40;ref&#46;14&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phase II&#44; multicenter&#44; randomized&#44; double-blind&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">302 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs Cal foam<br>vs BD foam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d&#44; 4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Success rate&#47;mPASI75 &#40;4 wk&#41;&#58;<br>Cal&#47;BD foam&#44; 45&#37;&#47;49&#37;<br>vs Cal foam&#44; 14&#46;9&#37;&#47;18&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>vs BD foam&#44; 30&#46;7&#37;&#47;34&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vs Cal&#47;BD ointment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Koo et al&#46; <span class="elsevierStyleItalic">J Dermatolog Treat&#46; 2016 &#40;ref&#46;25&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phase II&#44; multicenter&#44; randomized&#44; researcher-blinded&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">376 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs Cal&#47;BD ointment<br>vs foam vehicle<br>vs ointment vehicle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d&#44; 4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Success rate&#47;&#8595;mPASI &#40;4 wk&#41;&#58;<br>Cal&#47;BD foam&#44; 54&#46;6&#37;&#47;&#8595;74&#46;2&#37;<br>vs Cal&#47;BD ointment 43&#37;&#47;&#8595;63&#46;2&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vs vehicle<br>PSO-FAST study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Leonardi et al&#46; <span class="elsevierStyleItalic">J Drugs Dermatol&#46; 2015 &#40;ref&#46;26&#41;</span>&#59;<br><span class="elsevierStyleItalic">J Drugs Dermatol&#46; 2016 &#40;ref&#46;29&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phase III&#44; multicenter&#44; randomized&#44; double-blind&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">426 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs foam vehicle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d&#44; 4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Results &#40;wk 4&#41;<br>Success&#58; 53&#46;3&#37; vs 4&#46;8&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>mPASI&#58; 2 vs 5&#46;5 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>mPAS75&#58; 52&#46;9&#37; vs 8&#46;2&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>&#8595;70&#37; pruritus&#58; 83&#46;5&#37; vs 40&#46;6&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>DLQI &#40;0&#47;1&#41;&#58; 48&#46;1&#37; vs 21&#46;2&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vs Cal&#47;BD gel&#44;<br>PSO-ABLE study</td><td class="td" title="table-entry  " align="left" valign="top">Paul et al&#46; <span class="elsevierStyleItalic">J Eur Acad Dermatol Venereol&#46;</span><span class="elsevierStyleItalic">2017 &#40;ref&#46;27&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phase III&#44; multicenter&#44; randomized&#44; researcher-blinded&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">463 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs Cal&#47;BD gel<br>vs foam vehicle<br>vs gel vehicle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d&#44; 12 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Results &#40;4 wk vs 8 wk&#41;<br>Success&#58; 38&#37; vs 22&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>mPASI75&#58; 52&#37; vs 35&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>mPASI90&#58; 22&#37; vs 11&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>Success &#40;12 wk&#41;&#58; 44&#37; vs 34&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Paul et al&#46; <span class="elsevierStyleItalic">Am J Clin Dermatol&#46; 2017 &#40;ref&#46;30&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PSO-ABLE subgroup analysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">159 patients&#44; moderate to severe psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>77&#41;<br>vs Cal&#47;BD &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d&#44; 12 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Success &#40;4 wk&#41;&#58; 32&#37; vs 19&#37;<br>Success &#40;4 wk&#41;&#58; 36&#37; vs 17&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;<br>Success &#40;12 wk&#41;&#58; 38&#37; vs 32&#37;<br>mPASI75 &#40;4 wk 4&#41;&#58; 40&#37; vs 17&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>mPASI75 &#40;8 wk&#41;&#58; 53&#37; vs 22&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;<br>mPASI75 &#40;12 wk&#41;&#58; 57&#37; vs 35&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pooled data analysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Stein Gold et al&#46; <span class="elsevierStyleItalic">J Drugs Dermatol&#46; 2016 &#40;ref&#46;28&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pooled-data analysis of<br>Koo et al <span class="elsevierStyleItalic">&#40;ref&#46;25&#41;</span> &#43; Lebwohl et al <span class="elsevierStyleItalic">&#40;ref&#46;14&#41;</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><br>Leonardi et al <span class="elsevierStyleItalic">&#40;ref&#46;26&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1104 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs Cal foam<br>vs BD foam<br>vs Cal&#47;BD ointment<br>vs foam vehicle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d&#44; 4 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Success rate&#47;&#8595; mPASI&#47;PASI75 &#40;4 wk&#41;&#58;<br>Cal&#47;BD foam&#44; 51&#37;&#47;&#8595;72&#37;&#47;51&#37;<br>vs Cal&#47;BD ointment&#44; 43&#37;&#47;&#8595;63&#37;&#47;41&#37;<br>vs BD foam&#44; 31&#37;&#47;&#8595;53&#37;&#47;34&#37;<br>vs Cal foam&#44; 15&#37;&#47;&#8595;43&#37;&#47;18&#37;<br>vs vehicle foam&#44; 5&#37;&#47;&#8595;32&#37;&#47;7&#37;<br>vs vehicle ointment&#44; 8&#37;&#47;&#8595;33&#37;&#47;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleItalic">Safety</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tolerability data from efficacy trials&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Menter et al&#46; <span class="elsevierStyleItalic">Skinmed 2017</span><span class="elsevierStyleItalic">&#40;ref&#46;33&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pooled-data analysis of<br>Koo et al <span class="elsevierStyleItalic">&#40;ref&#46;25&#41;</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Lebwohl et al <span class="elsevierStyleItalic">&#40;ref&#46;14&#41;</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><br>Leonardi et al <span class="elsevierStyleItalic">&#40;ref&#46;26&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1104 patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs Cal foam<br>vs BD foam<br>vs Cal&#47;BD ointment<br>vs foam vehicle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d&#44; 12 wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">AE&#58; Cal&#47;BD foam&#44; 13&#46;8&#37; &#40;NS vs others&#41;<br>ADR&#58; Cal&#47;BD foam 2&#46;7&#37;<br>vs 3&#37; Cal&#47;BD ointment<br>vs 6&#46;1&#37; Cal foam<br>vs 7&#46;1&#37; BD foam<br>Most common ADR to Cal&#47;BD foam&#58; pain &#40;4&#47;564&#41; and pruritus &#40;2&#47;564&#41; at application site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Potential for irritation and sensitization&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Queille-Roussel et al&#46; <span class="elsevierStyleItalic">J Am Acad Dermatol&#46; 2015 &#40;ref&#46;32&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phase I&#44; single center&#44; randomized&#44; controlled&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">213 healthy volunteers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam<br>vs foam vehicle<br>vs white petroleum jelly &#40;negative control&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 applications&#47;wk &#40;semiocclusive patches&#41; for 3 wk<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>2 wk rest<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1 application&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Low irritative potential<br>Maximum score&#44; 2 &#40;erythema with mild to moderate edema in 3&#47;213 volunteers&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MUSE &#40;Maximum Use and Systemic Exposure&#41; trial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Taraska et al&#46; <span class="elsevierStyleItalic">J Cutan Med Surg&#46; 2016 &#40;ref&#46;34&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Phase II&#44; multicenter&#44; open-label&#44; uncontrolled&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 patients&#44; moderate to severe psoriasis BSA&#58; 15&#37;&#8211;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cal&#47;BD foam&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 application&#47;d<br>4 wk<br>13&#46;5&#8211;113<span class="elsevierStyleHsp" style=""></span>g&#47;wk&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ACTH challenge test&#58; normal<br>Albumin-corrected calcium level<br>&#58; normal<br>24-h urinary calcium&#58; normal<br>Calcium&#8211; creatinine ratio in urine&#58; normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                    0 => array:2 [
                      "titulo" => "Prevalence of psoriasis in Spain in the age of biologics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Ferr&#225;ndiz"
                            1 => "J&#46;M&#46; Carrascosa"
                            2 => "M&#46; Toro"
                          ]
                        ]
                      ]
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                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2013.12.008"
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                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2014"
                        "volumen" => "105"
                        "paginaInicial" => "504"
                        "paginaFinal" => "509"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24569109"
                            "web" => "Medline"
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              "identificador" => "bib0190"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of biologics in the treatment of moderate-to-severe plaque psoriasis&#58; A systematic review and meta-analysis of randomized controlled trials with different time points"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Puig"
                            1 => "A&#46; L&#243;pez"
                            2 => "E&#46; Vilarrasa"
                            3 => "I&#46; Garc&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jdv.12238"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24033851"
                            "web" => "Medline"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Predictors of biologic treatment of psoriasis&#58; A non-interventional study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Puig"
                            1 => "T&#46; Fan"
                            2 => "Q&#46; Ding"
                            3 => "N&#46;E&#46; Smith"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2147/CEOR.S54797"
                      "Revista" => array:6 [
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Spanish evidence-based guidelines on the treatment of psoriasis with biologic agents&#44; 2013&#46; Part 1&#58; on efficacy and choice of treatment"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Spanish Psoriasis Group of the Spanish Academy of Dermatology and Venereology"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Puig"
                            1 => "J&#46;M&#46; Carrascosa"
                            2 => "G&#46; Carretero"
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                            4 => "R&#46;F&#46; Lafuente-Urrez"
                            5 => "I&#46; Belinch&#243;n"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.adengl.2013.04.013"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24018211"
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Adherence and patient satisfaction with topical treatment in psoriasis&#44; and the use&#44; and organoleptic properties of such treatments&#58; A Delphi study with an expert panel and members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology"
                      "autores" => array:1 [
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                          "autores" => array:6 [
                            0 => "L&#46; Puig"
                            1 => "J&#46;M&#46; Carrascosa"
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