Topical Treatment for Psoriasis

Topical psoriasis treatment includes corticosteroids, calcipotriol/calcipotriene, tazarotene, tars and anthralin. Tars and anthralin are discussed above.

Topical corticosteroids:

Topical steroids are the most commonly prescribed psoriasis medications, and they are available as creams, ointments, gels, lotions, solutions, oils and shampoos. They can be used anywhere on the body. They work quite quickly, often within 1—2 weeks. However with long-term use, steroids often lose their effectiveness. Usually you won’t have any side-effects with short-term use. However, longer use, particularly with stronger preparations, may cause thinning of the skin, stretch marks, dilated blood vessels, rosacea, perioral dermatitis, bruising, hair growth, progression to a more active form of psoriasis (for example, pustular or erythrodermic psoriasis), increased susceptibility to infections, and a flare-up of the psoriasis when the medication is stopped. Topical corticosteroids can be absorbed into the blood circulation and cause a number of side-effects in your body, particularly if you are treating large areas and/or using strong steroids. Only mild steroids should be used on the more sensitive skin, such as your face, and in skin folds. Stronger steroids are usually required elsewhere. Pulsed betamethasone diproprionate used three times, 12 hours apart is shown to be useful in maintaining psoriasis. This regimen is suitable for weekend use while non-cortisone can be used during the weekdays.

Topical calcipotriol/calcipotriene:

Calcipotriol/calcipotriene is a derivative of vitamin D, and it is available in a cream, ointment and scalp solution. The onset of action is usually slower (could take up to 2 months) than with topical steroids, but it is usually effective and safe for long-term use. Only 100 g/week should be used, as it is possible to alter your calcium metabolism with the risk of forming calcium kidney stones. Since it may cause irritation, it is not usually used on the face, genitals or in skin folds.

It can be combined with UVB therapy, and increases its effectiveness. UV light, salicylic acid, lactic acid, and tazarotene deactivate calcipotriol. It is compatible with tar gels that are used at the same time on the skin.

Topical tazarotene:

Tazarotene is a selective retinoid with properties that are similar to vitamin A. Tazarotene is available as a cream and gel. It is effective in the treatment of psoriasis, acne and photoaging. In the treatment of psoriasis, it may be used by itself or in combination with a corticosteroid cream or ointment, calcipotriol/calcipotriene or light treatment (UVB, PUVA). Irritation is common with tazarotene, but you can minimize this by applying a thin layer of the medication only to the patches and avoiding the uninvolved surrounding skin and/or protecting the surrounding skin with petrolatum. You should not use tazarotene on the genitals or in the skin folds. You should not use this medication if you are pregnant.

Click here to view the A-Detail™ on Dovobet®, a mix of calcipotriol and the corticosteroid betamethasone dipropionate.

Dovobet®

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INTRODUCTION
Dovobet (50 micrograms/gram calcipotriol and 0.5 milligrams/gram betamethasone dipropionate) is a topical ointment approved for use in Canada to treat plaque psoriasis. Dovobet has become the topical therapy of choice for many patients with plaque type psoriasis not involving the face or skin folds... | Read more ...

CLININCAL EXPERIENCE
More than six international studies involving over 6,000 patients have shown reductions in the PASI (Psoriasis Area and Severity Index) of approximately 40% after one week of treatment and 70% after four weeks... | Read more ...

INDICATIONS
Used to treat chronic plaque psoriasis that covers less than 30% of the body surface (see following slides for clarification). Dovobet is not often used to treat the scalp because the sticky base does not allow for easy application or removal... | Read more ...

PATIENT PROFILE
Patients with chronic plaque psoriasis that covers less than 30% of the body surface. In some cases, a patient could use it on a greater BSA if he/she wanted to as long as the use/week is 100 g per week or less... | Read more ...

DOSING
Dovobet should be applied to the affected area once daily for four weeks. Several studies have shown that there are no statistically significant differences between applying the ointment once daily or twice daily... | Read more ...

EFFICACY
Six international studies involving more than 6,000 patients using Dovobet to treat psoriasis have shown PASI reductions of approximately 40% after one week of treatment and 70% after four weeks. Additional studies have shown that Dovobet has superior... | Read more ...

COMPLIANCE
Compliance is aided by the convenience of the once daily dosing of Dovobet. Compliance is also less of a problem than with most products due to the rapid onset of action. Significant improvement is usually seen within the first week... | Read more ...

SIDE EFFECTS, SAFETY AND RISKS
Because Dovobet is a combination drug, the frequency of side effects reported is less than would be expected if using each compound on its own: for example, the anti-inflammatory action of the corticosteroid (betamethasone dipropionate) minimizes the irritation often reported when using calcipotriol alone... | Read more ...

COST OF TREATMENT
It is probably the single most effective topical therapy available for psoriasis, so patients are generally prepared to pay for this. It is somewhat more expensive than the equivalent potent topical steroid, but the rapid and significant improvement in quality of life... | Read more ...

View the entire Dovobet^® presentation.

Dovobet®

Close | Move

INTRODUCTION
Dovobet (50 micrograms/gram calcipotriol and 0.5 milligrams/gram betamethasone dipropionate) is a topical ointment approved for use in Canada to treat plaque psoriasis. Dovobet has become the topical therapy of choice for many patients with plaque type psoriasis not involving the face or skin folds... | Read more ...

CLININCAL EXPERIENCE
More than six international studies involving over 6,000 patients have shown reductions in the PASI (Psoriasis Area and Severity Index) of approximately 40% after one week of treatment and 70% after four weeks... | Read more ...

INDICATIONS
Used to treat chronic plaque psoriasis that covers less than 30% of the body surface (see following slides for clarification). Dovobet is not often used to treat the scalp because the sticky base does not allow for easy application or removal... | Read more ...

PATIENT PROFILE
Patients with chronic plaque psoriasis that covers less than 30% of the body surface. In some cases, a patient could use it on a greater BSA if he/she wanted to as long as the use/week is 100 g per week or less... | Read more ...

DOSING
Dovobet should be applied to the affected area once daily for four weeks. Several studies have shown that there are no statistically significant differences between applying the ointment once daily or twice daily... | Read more ...

EFFICACY
Six international studies involving more than 6,000 patients using Dovobet to treat psoriasis have shown PASI reductions of approximately 40% after one week of treatment and 70% after four weeks. Additional studies have shown that Dovobet has superior... | Read more ...

COMPLIANCE
Compliance is aided by the convenience of the once daily dosing of Dovobet. Compliance is also less of a problem than with most products due to the rapid onset of action. Significant improvement is usually seen within the first week... | Read more ...

SIDE EFFECTS, SAFETY AND RISKS
Because Dovobet is a combination drug, the frequency of side effects reported is less than would be expected if using each compound on its own: for example, the anti-inflammatory action of the corticosteroid (betamethasone dipropionate) minimizes the irritation often reported when using calcipotriol alone... | Read more ...

COST OF TREATMENT
It is probably the single most effective topical therapy available for psoriasis, so patients are generally prepared to pay for this. It is somewhat more expensive than the equivalent potent topical steroid, but the rapid and significant improvement in quality of life... | Read more ...

View the entire Dovobet^® presentation.