Calcipotriol Plus Short-Contact Dithranol: A Novel Topical Combination Therapy for Chronic Plaque Psoriasis

Abstract

The purpose of this double-blind randomised parallel-group study was to compare the efficacy and safety of short-contact treatment with dithranol ointment (2%) with its combination with calcipotriol ointment (50 µg/g) in 2 groups of in-patients with chronic plaque psoriasis. The patients of the first group (n = 23) topically applied dithranol once daily for 30 min and the vehicle of calcipotriol twice daily. The patients of the second group (n = 23) used a single topical application of dithranol for 30 min daily and additionally applied calcipotriol twice daily. The extent and the severity of psoriasis were assessed by means of psoriasis area and severity index score (PASI score) before the onset of the 6-week therapy and weekly thereafter. The difference between the two groups with regard to the mean PASI score became statistically significant already after the first week of treatment and remained so until the end of the trial. No significant differences were observed between the two groups with respect to the cutaneous adverse events. These findings indicate that the addition of calcipotriol ointment to short-contact dithranol markedly augments the therapeutic efficacy of the latter in chronic plaque psoriasis and impressively accelerates the response of psoriatic plaques to this well-tolerated regimen.

S3 – Guidelines on the treatment of psoriasis vulgaris (English version). Update

“…A total of 15 studies fulfilled the criteria for inclusion in the guidelines. For dithranol monotherapy, there was one grade A 2 study [96], 11 grade B studies [97–107], and 1 grade C study [108]. The result is an evidence level of 2.…”

“…In studies on short‐contact therapy, Monastirli et al (EG A 2 ) showed that in 23 patients, after six weeks, there was a reduction in the PASI score of 8.01 ± 1.44 to 1.21 ±1 [96]. The efficacy of short‐contact dithranol therapy was also reported in studies by Agrup et al (EG B; 27 of 36 patients had complete or nearly complete healing of lesions after five weeks using dithranol pen vs. dithranol paste), Prins et al (EG B; eight out of eight after an average of 12.3 weeks or six out of eight after 13.1 weeks, 2 X/daily vs. 3 X/weekly), and de Mare et al (EG B; 14 of 20 patients had complete or nearly complete clearance after six weeks) [97, 98, 103].…”

“…None of the 23 patients given dithranol monotherapy achieved total remission (PASI reduction of 100%); 23 out of 23 achieved partial remission (PASI reduction of 75%) after six weeks. Combination therapy achieved complete remission in all 23 patients [96]. The Cochrane review by Mason showed compared dithranol with vitamin D 3 derivatives (tacalcitol, calcitriol, and calcipotriol).…”

S3 – Guidelines on the treatment of psoriasis vulgaris Update 2011

“…For dithranol monotherapy, there was one grade A 2 study [96], 11 grade B studies [97][98][99][100][101][102][103][104][105][106][107], and 1 grade C study [108]. For dithranol monotherapy, there was one grade A 2 study [96], 11 grade B studies [97][98][99][100][101][102][103][104][105][106][107], and 1 grade C study [108].…”

Evidence‐based (S3) guidelines for the treatment of psoriasis vulgaris

“…A total of 14 studies fulfill the inclusion criteria of the Guidelines; of these one study was assessed with the GE A2 [56], ten with the GE B [57–66] and one with the GE C [55] regarding monotherapy with dithranol. This results in LE 2.…”