Calcipotriol ointment in nail psoriasis: a controlled double-blind comparison with betamethasone dipropionate and salicylic acid

Abstract

This double-blind randomized study was designed to compare the efficacy and safety of calcipotriol ointment (50 microg/g) with betamethasone dipropionate (64 mg/g) and salicylic acid (0.03 g/g) ointment in the treatment of nail bed psoriasis. Fifty-eight patients applied the given drug to the affected nails twice a day for 3-5 months, depending on clinical response. Efficacy was assessed monthly on the basis of nail thickness, measured in millimetres. Photographs of the treated nails were taken at baseline, and after 3 and 5 months. Tolerability was assessed at 3 and 5 months. In patients with fingernail psoriasis, after 3 months of treatment subungual hyperkeratosis was reduced from 2.3 +/- 0.1 mm (mean +/- SEM) to 1.5 +/- 0.1 mm (-26.5%) in the calcipotriol group and from 2.3 +/- 0.1 mm to 1.6 +/- 0.1 mm (-30.4%) in the betamethasone dipropionate and salicylic acid group [not significant (NS) between treatments, analysis of variance (ANOVA)]. After 5 months, responders showed a 49.2% reduction in hyperkeratosis in the calcipotriol group (from 2.8 +/- 0.1 mm to 1.4 +/- 0.2 mm) and 51.7% (from 2.1 +/- 0.1 mm to 1.0 +/- 0.1 mm) in the betamethasone dipropionate and salicylic acid group (P < 0.001 from baseline, NS between treatments, ANOVA). In patients with toenail psoriasis, after 3 months of treatment there was an overall reduction in hyperkeratosis from 2.6 +/- 0.1 mm to 2.1 +/- 0.1 mm (-20.1%) in the calcipotriol group and from 3.0 +/- 0.1 mm to 2.3 +/- 0.1 mm (-22. 9%) in the betamethasone dipropionate and salicylic acid group (P < 0.001 from baseline, NS between treatments, ANOVA). By the end of the fifth month there was a 40.7% reduction in hyperkeratosis in the calcipotriol group (from 2.1 +/- 0.1 mm to 1.2 +/- 0.1 mm) and 51.9% in the betamethasone dipropionate and salicylic acid group (from 2.7 +/- 0.1 mm to 1.3 +/- 0.1 mm; P < 0.0001 from baseline, NS between treatments, ANOVA). The results of the study show that calcipotriol is as effective as a combination of a topical steroid with salicylic acid in the treatment of nail psoriasis and represents a safe alternative in the topical treatment of nail psoriasis.

Treatment and Management of Psoriasis with Nail Involvement: A Focus on Biologic Therapy

“…Both treatments demonstrated similar levels of response in reducing subungual hyperkeratosis; however, only about half of the patients responded to treatment [17]. Rigopoulos et al confirmed the benefits of using topical calcipotriol in combination with a topical steroid cream in an open-label study utilising calcipotriol cream on weekdays and clobetasol propionate at weekends over 6 months.…”

“…A double-blind, randomised study compared the efficacy of twice-daily calcipotriol ointment with a combination of betamethasone dipropionate and salicylic acid ointment in 58 patients with nail psoriasis over 3 months [17]. Both treatments demonstrated similar levels of response in reducing subungual hyperkeratosis; however, only about half of the patients responded to treatment [17].…”

Treatment of Nail Psoriasis with a Two-Compound Formulation of Calcipotriol plus Betamethasone Dipropionate Ointment

“…Calcipotriol twice daily for 3–6 months, either as monotherapy or in conjunction with topical corticosteroids, has been evaluated in the treatment of nail psoriasis in several studies [10,11,12], even though no study utilized the NAPSI to evaluate the results. In the population under study, the patients exhibited significant improvement of nail signs correlated with nail bed psoriasis (subungual hyperkeratosis, onycholysis, oil drop and pitting) using the two-compound formulation (fig.…”

Topical Therapies for Psoriasis

“…A comparison of calcipotriol ointment with a combination of betamethasone dipropionate and salicylic acid ointment (Diprosalic) showed that calcipotriol was as effective as the combination product for treating nail psoriasis (Tosti et al, 1998). Comparisons of 0.005% calcipotriol ointment and 5% coal tar ointment in conjunction with sun exposure in 10 adult patients with stable plaque psoriasis showed that both calcipotriol and coal tar ointment had comparable efficacies in treating stable plaque psoriasis when used simultaneously with sun exposure, although the initial response to calcipotriol was faster (Kaur et al, 2001).…”

“…The calcipotriol cream is effective in treatment of plaque psoriasis and statistically significantly better than the placebo alone (Staberg et al, 1989). In addition, a solution has been developed for scalp psoriasis (Klaberg et al, 1994), and calcipotriol ointment has also been investigated for nail psoriasis (Tosti et al, 1998).…”