Información del artículo
Abstract
Topical therapy continues to be one of the pillars of psoriasis management. Topical corticosteroids and vitamin D analogs are the drugs of choice during the induction phase, and vitamin D analogs continue to be drugs of choice for maintenance therapy. Tazarotene and dithranol are suitable options in patients with certain, specific characteristics. The calcineurin inhibitors can be considered to be second-line treatment for psoriasis of the face and flexures. The efficacy and safety of the fixed-dose combination of betamethasone and calcipotriol in the induction phase is greater than that of either drug alone. The combination of corticosteroids with salicylic acid achieves better results than corticosteroids in monotherapy. None of the drugs evaluated stands out over the others in all clinical situations, and their use must therefore be individualized in each patient and adjusted according to the course of the disease.
Key words:
psoriasis
topical treatment
therapy
Resumen
La terapia tópica sigue representando un pilar fundamental y de actualidad en el manejo de la psoriasis. Los corticoides tópicos y los análogos de la vitamina D son los principios activos de elección durante la fase de inducción, mientras que estos últimos se mantienen como alternativa de elección en el mantenimiento. El tazaroteno y el ditranol resultan alternativas adecuadas en pacientes con determinadas características. Los inhibidores de la calcineurina pueden considerarse tratamientos de segunda línea en la psoriasis de la cara y las flexuras. La eficacia y la seguridad en la fase de inducción de la combinación en dosis fija de betametasona y calcipotriol es superior a la obtenida por ambos principios activos por separado. La combinación de corticoides con ácido salicílico aporta ventajas con respecto a los corticoides en monoterapia. Ninguno de los principios activos evaluados presenta ventajas sobre el resto en todas las situaciones clínicas, por lo que su empleo debe individualizarse para cada paciente y para cada momento evolutivo de la dermatosis.
Palabras clave:
psoriasis
tratamiento tópico
terapéutica
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References
[1.]
C. Ferrándiz, X. Bordas, V. García-Patos, S. Puig, R. Pujol, A. Smandía.
Prevalence of psoriasis in Spain (Epiderma Project: phase I).
J Eur Acad Dermatol Venereol, 15 (2001), pp. 20-23
[2.]
J.M. Carrascosa, R. Pujol, E. Daudén, J.M. Hernanz-Hermosa, X. Bordas, J.A. Smandia, et al.
A prospective evaluation of the cost of psoriasis in Spain (EPIDERMA project: phase II).
J Eur Acad Dermatol Venereol, 20 (2006), pp. 840-845
[3.]
P.C. Van de Kerkhof, W.H. Vissers.
The topical treatment of psoriasis.
Skin Pharmacol Appl Skin Physiol, 16 (2003), pp. 69-83
[4.]
S. Liden.
Optimal efficacy of topical corticoids in psoriasis.
Sem Dermatol, 11 (1992), pp. 275-277
[5.]
J. Mason, A.R. Mason, M.J. Cork.
Topical preparations for the treatment of psoriasis: a systematic review.
Br J Dermatol, 146 (2002), pp. 351-364
[6.]
H. Svartholm, B. Larsson, B. Frederiksen.
Intermittent topical treatment of psoriasis with clobetasol propionate.
Curr Med Res Opin, 8 (1982), pp. 154-157
[7.]
N. Lowe, S.R. Feldman, D. Sherer, J. Weiss, J.S. Shavin, L.Y. Lin, et al.
Clobetasol propionate lotion, an efficient and safe alternative to clobetasol emollient cream in subjects with moderate to severe plaque-type psoriasis.
J Dermatol Treatment, 6 (2005), pp. 158-164
[8.]
J.J. Miller, D. Roling, D. Margolis, C. Guzzo.
Failure to demonstrate therapeutic tachyphylaxis to topically applied steroids in patients with psoriasis.
J Am Acad Dermatol, 41 (1999), pp. 546-549
[9.]
A.E. Tauscher, A.B. Fleischer Jr, K.C. Phelps, S.R. Feldman.
Psoriasis and pregnancy.
J Cutan Med Surg, 6 (2002), pp. 561-570
[10.]
B.R. Lagos, A.I. Maibach.
Frequency of application of topical corticosteroids: an overview.
Br J Dermatol, 139 (1998), pp. 763-766
[11.]
R. Kirkland, D.J. Pearce, S.R. Feldman.
Critical factors determining the potency of topical corticosteroids.
J DermatolTreatment, 17 (2006), pp. 133-135
[12.]
D.M. Ashcroft, A.L. Po, H.C. Williams, C.E. Griffiths.
Systematic review of comparative efficacy and tolerability of calcipotriol in treating chronic plaque psoriasis.
BMJ, 320 (2000), pp. 963-997
[13.]
J.F. Bourke, S.J. Iqbal, P.E. Hutchinson.
A randomized double-blind comparison of the effects on systemic calcium homeostasis of topical calcitriol (3 micrograms/g) and calcipotriol (50 micrograms/g) in the treatment of chronic plaque psoriasis vulgaris.
Acta Derm Venereol, 77 (1997), pp. 228-230
[14.]
N.K. Veien, J.R. Bjerke, I. Rossmann-Ringdahl, H.B. Jakobsen.
Once daily treatment of psoriasis with tacalcitol compared with twice daily treatment with calcipotriol. A double-blind trial.
Br J Dermatol, 137 (1997), pp. 581-586
[15.]
J.M. Camarasa, J.P. Ortonne, L. Dubertret.
Calcitriol shows greater persistence of treatment effect than betamethasone dipropionate in topical psoriasis therapy.
J Dermatolog Treat, 14 (2003), pp. 8-13
[16.]
C.A. Ramsay, J. Berth-Jones, G. Brundin, W.J. Cunliffe, L. Dubertret, P.C. van de Kerkhof, et al.
Long-term use of topical calcipotriol in chronic plaque psoriasis.
Dermatology, 189 (1994), pp. 260-264
[17.]
J. Berth-Jones, J.F. Bourke, S.J. Iqbal, P.E. Hutchinson.
Urine calcium excretion during treatment of psoriasis with topical calcipotriol.
Br J Dermatol, 129 (1993), pp. 411-414
[18.]
C.R. Darley, W.J. Cunliffe, C.M. Green, P.E. Hutchinson, M.R. Klaber, N. Downes.
Safety and efficacy of calcipotriol ointment (Dovonex) in treating children with psoriasis vulgaris.
Br J Dermatol, 135 (1996), pp. 390-393
[19.]
K. Kragballe, J. Austad, L. Barnes, A. Bibby, M. de la Brassinne, F. Cambazard.
A 52-week randomized safety study of a calcipotriol/betamethasone dipropionate two-compound product (Dovobet/Daivobet/Taclonex) in the treatment of psoriasis vulgaris.
Br J Dermatol, 154 (2006), pp. 1155-1160
[20.]
K. Kragballe, B.T. Gjertsen, D. De Hoop, T. Karlsmark, P.C. van de Kerkhof, O. Larko, et al.
Double-blind, right/left comparison of calcipotriol and betamethasone valerate in treatment of psoriasis vulgaris.
Lancet, 337 (1991), pp. 193-196
[21.]
K. Kragballe, P.C. van de Kerkhof.
Consistency of data in six phase III clinical studies of a two-compound product containing calcipotriol and betamethasone dipropionate ointment for the treatment of psoriasis.
J Eur Acad Dermatol Venereol, 20 (2006), pp. 39-44
[22.]
R. Kaufmann, A.J. Bibby, R. Bissonnette, F. Cambazard, A.C. Chu, J. Decroix, et al.
A new calcipotriol/betamethasone dipropionate formulation (Daivobet) is an effective once-daily treatment for psoriasis vulgaris.
Dermatology, 205 (2002), pp. 389-393
[23.]
L. Guenther, P.C. Van de Kerkhof, E. Snellman, K. Kragballe, A.C. Chu, E. Tegner, et al.
Efficacy and safety of a new combination of calcipotriol and betamethasone dipropionate (once or twice daily) compared to calcipotriol (twice daily) in the treatment of psoriasis vulgaris: a randomized, double-blind, vehicle controlled clinical trial.
Br J Dermatol, 147 (2002), pp. 316-323
[24.]
K.A. Papp, L. Guenther, B. Boyden, F.G. Larsen, R.J. Harvima, J.J. Guilhou, et al.
Early onset of action and efficacy of a combination of calcipotriene and betamethasone dipropionate in the treatment of psoriasis.
J Am Acad Dermatol, 48 (2003), pp. 48-54
[25.]
W.S. Douglas, Y. Poulin, J. Decroix, J.P. Ortonne, U. Mrowietz, W. Gulliver, et al.
A new calcipotriol/betamethasone formulation with rapid onset of action was superior to monotherapy with betamethasone dipropionate or calcipotriol in psoriasis vulgaris.
Acta Derm Venereol, 82 (2002), pp. 131-135
[26.]
K. Kragballe, K. Noerrelund, H. Lui, J.P. Ortonne, G. Wozel, T. Uurasmaa, et al.
Efficacy of once daily treatment regimens with calcipotriol/betamethasone dipropionate ointment and calcipotriol ointment in psoriasis vulgaris.
Br J Dermatol, 150 (2004), pp. 1167-1173
[27.]
J.P. Ortonne, R. Kaufmann, M. Lecha, M. Goodfield.
Efficacy of treatment with calcipotriol/betamethasone dipropionate followed by calcipotriol alone compared with tacalcitol for the treatment of psoriasis vulgaris: a randomised, double-blind trial.
Dermatology, 209 (2004), pp. 308-313
[28.]
S. White, R. Vender, D. Thaçi, C. Haverkamp, J.M. Naeyaert, R. Foster, et al.
Use of calcipotriene cream (Dovonex cream) following acute treatment of psoriasis vulgaris with the calcipotriene/betamethasone dipropionate two-compound product (Taclonex). A randomized, parallel-group clinical trial.
Am J Clin Dermatol, 7 (2006), pp. 177-184
[29.]
A.V. Anstey, K. Kragballe.
Retrospective assessment of PASI50 and PASI 75 attainment with a calcipotriol/betamethasone dipropionate ointment.
Int J Dermatol, 45 (2006), pp. 970-975
[30.]
K. Kragballe, K. Noerrelund, H. Lui, J.P. Ortonne, G. Wozel, T. Uurasmaa, et al.
Efficacy of once daily treatment regimens with calcipotriol/betamethasone dipropionate ointment and calcipotriol ointment in psoriasis vulgaris.
Br J Dermatol, 150 (2004), pp. 1167-1173
[31.]
K. Kragballe, J. Austad, L. Barnes, A. Bibby, M. de la Brassinne, F. Cambazard.
Efficacy results of a 52-week, randomised, double-blind, safety study of a calcipotriol/betamethasone dipropionate two-compound product (Daivobet/Dovobet/Taclonex) in the treatment of psoriasis vulgaris.
Dermatology, 213 (2006), pp. 319-326
[32.]
E. Herrera, S. Habicheyn, M.V. Mendiola Fernández, M.V. Barrera Vigo, A. Tejera.
Therapeutic response of psoriasis to calcipotriol/betamethasone dipropionate ointment combined with biologics therapy (poster).
15th Congress of the European Academy of Dermatology and Venereology,
[33.]
R. Gamo, J.L. López-Estebaranz.
Terapia biológica y psoriasis.
Actas Dermosifiliogr, 97 (2006), pp. 1-17
[34.]
M. Lebwohl.
The role of salicylic acid in the treatment of psoriasis.
Int J Dermatol, 38 (1999), pp. 16-24
[35.]
L.C. Guenther.
Fixed-dose combination therapy for psoriasis.
Am J Dermatol, 5 (2004), pp. 71-77
[36.]
J. Koo, C.A. Cuffie, D.J. Tanner.
Mometasone furoate 0.1%/salicylic acid 5% ointment versus mometasone furoate 0.1% in the treatment of moderate-to-severe psoriasis: a multicenter study.
Clin Ther, 20 (1998), pp. 283-291
[37.]
R.S. Medansky, C.A. Cuffie, D.J. Tanner.
Mometasone furoate 0.1%/salicylic acid 5% ointment twice daily versus fluocinonide 0.05% ointment twice daily in the management of patients with psoriasis.
Clin Ther, 19 (1997), pp. 701-709
[38.]
H.I. Katz, D.J. Tanner, C.A. Cuffie.
A comparison of the efficacy and safety of the combination Mometasone furoate 0.1%/salicylic acid 5% ointment with each of its component in psoriasis.
J Dermatol Treat, 9 (1998), pp. 151-156
[39.]
C.H. Endzweig-Gribetz, C. Brady, C. Lynde, D. Sibbald, M. Lebwohl.
Drug interactions in psoriasis: the pros and cons of combining topical psoriasis therapies.
J Cutan Med Surg, 6 (2002), pp. 12-16
[40.]
G.D. Weinstein.
Safety, efficacy, and duration of therapeutic effect of tazarotene used in the treatment of plaque psoriasis.
Br J Dermatol, 135 (1996), pp. 32-36
[41.]
G.D. Weinstein, E. Jeffes, M. Duvic.
Tazarotene gel for the treatament of plaque psoriasis: A double-blind clinical study. Vancouver 1996.
Clin Dermatol, (2000),
[42.]
M. Lebwohl, E. Ast, J.P. Callen, S.I. Cullen, S.R. Hong, C.L. Kulp-Shorten, et al.
Once-daily tazarotene gel versus twice-daily fluocinonide cream in the treatment of plaque psoriasis.
J Am Acad Dermatol, 38 (1998), pp. 705-711
[43.]
J.Y. Koo, D. Martin.
Investigator-masked comparison of tazarotene gel q.d. plus mometasone furoate cream q.d. vs. mometasone furoate cream b.i.d. in the treatment of plaque psoriasis.
Int J Dermatol, 40 (2001), pp. 210-212
[44.]
R.K. Scher, M. Stiller, Y.I. Zhu.
Tazarotene 0.1% gel in the treatment of fingernail psoriasis: a double-blind, randomized, vehicle-controlled study.
Cutis, 68 (2001), pp. 355-358
[45.]
H. Gollnick, A. Menter.
Combination therapy with tazarotene plus a topical corticosteroid for the treatment of plaque psoriasis.
Br J Dermatol, 140 (1999), pp. 18-23
[46.]
L. Naldi, C.F. Carrel.
Development of anthralin short-contact therapy in psoriasis: survey of published clinical trials.
Int JDermatol, 31 (1992), pp. 126-130
[47.]
O.Q. Sminkels, M. Prins, R.T. Veeniiuis, T. De Boo, M.J. Gerritsen, G.J. Van Der Wilt, et al.
Effectiveness and side effects of UVB-phototherapy, dithranol inpatient therapy and acare instruction programme of short contact dithranol inmoderate to severe psoriasis.
Eur J Dermatol, 14 (2004), pp. 159-165
[48.]
J. Berth-Jones, A.C. Chu, W.A. Dodd.
A multicentre, parallel group comparison of calcipotriol ointment and short-contact dithranol treatment in chronic plaque psoriasis.
Br J Dermatol, 127 (1992), pp. 266-271
[49.]
P.C. Van de Kerkhof, P.G. van der Valk, O.Q. Swinkels, M. Kucharekova, M.A. de Rie, H.J. de Vries.
A comparison of twice-daily calcipotriol ointment with once-daily short-contact dithranol cream therapy: a randomised controlled trial of supervised treatment of psoriasis vulgaris in a day-care setting.
Br J Dermatol, 155 (2006), pp. 800-807
[50.]
S.R. McBride, P. Walter, N.J. Reynolds.
Optimizing the frequency of outpatient short contact dithranol treatment used in combination with broadband ultraviolet B for psoriasis: a randomised, within-patient controlled trial.
Br J Dermatol, 149 (2003), pp. 1259-1265
[51.]
O.Q. Swinkels, M. Prins, M. Kucharekova, T. de Boo, M.J. Gerritsen, P.G. van der Valk, et al.
Combining lesional short-contact dithranol therapy of psoriasis with potent topical corticosteroid.
Br J Dermatol, 146 (2002), pp. 621-626
[52.]
A. Monastirli, S. Georgiou, E. Pasmatzi.
Calcipotriol plus short-contact dithranol: a novel topical combination therapy for chronic plaque psoriasis.
Skin Pharmacol Appl Skin Physiol, 15 (2002), pp. 246-251
[53.]
I.M. Zonneveld, A. Rubins, S. Jablonska, A. Dobozy, T. Ruzicka, P. Kind, et al.
Topical tacrolimus is not effective in chronic plaque psoriasis. A pilot study.
Arch Dermatol, 134 (1998), pp. 1101-1102
[54.]
T. Yamamoto, K. Nishioka.
Topical tacrolimus: an effective therapy for facial psoriasis.
Eur J Dermatol, 13 (2003), pp. 471-473
[55.]
M. Lebwohl, A.K. Freeman, M.S. Chapman, S.R. Feldman, J.E. Hartle, A. Henning.
Tacrolimus ointment is effective for facial and intertriginous psoriasis.
J Am Acad Dermatol, 51 (2004), pp. 723-730
[56.]
C. Gribetz, M. Ling, M. Lebwohl, D. Pariser, Z. Draelos, A.B. Gottlieb, et al.
Pimecrolimus cream 1% in the treatment of intertriginous psoriasis: a double-blind, randomized study.
J Am Acad Dermatol, 51 (2004), pp. 731-738
[57.]
P.H. Bowman, J.E. Maloney, J.Y. Koo.
Combination of calcipotriene (Dovonex) ointment and tazarotene in the treatment of plaque psoriasis: a pilot study.
J Am Acad Dermatol, 46 (2002), pp. 907-913
[58.]
D.A. Brualla, M. Sánchez-Regaña, J. Massana.
Optimización de la fototerapia UVB 311 nm con ácido oleico.
Actas Dermosifiliogr, 94 (2003), pp. 66-67
[59.]
J.M. Carrascosa, J. Gardeazábal, A. Pérez-Ferriols, A. Alomar, P. Manrique, M. Jones-Caballero, et al.
Grupo Español de Fotobiología. Documento de consenso en fototerapia: terapia PUVA y terapia UVB de banda estrecha.
Actas Dermosifiliogr, 96 (2005), pp. 635-658
[60.]
J.H. Rim, J.Y. Park, Y.B. Choe.
The efficacy of calcipotriol + acitretin combination therapy for psoriasis. Comparison with acitretin monotherapy.
Am J Clin Dermatol, 4 (2003), pp. 507-510
[61.]
S. Lamba, M. Lebwohl.
Combination therapy with vitamin D analogs.
Br J Dermatol, 144 (2001), pp. 27-32
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