Dithranol in a Cream Preparation: Disperse or Dissolve?

Abstract

In the search for the ideal dithranol cream preparation for short-contact treatment of psoriasis, we investigated the clinical efficacy, side effects and patient appreciation of two dithranol cream preparations (cream A and B) in a double-blind left-right comparing study. Dithranol was dissolved at preparation in cream A and dispersed in cream B. Cream A is known to have a shelf life of 1 year, while cream B has a much shorter shelf life (several months). Ten patients with chronic plaque-type psoriasis were treated during 7 weeks in a short-contact regimen. The clinical efficacy was monitored by scoring of erythema, induration, scaling and involved area (PASI); skin irritation was scored visually, and patient appreciation was evaluated by means of a multiple-choice questionnaire. Dispersion of dithranol in a cream was associated with less irritation and less discoloration of the skin, and its efficacy was comparable with that of the cream in which the dithranol was dissolved. As the dispersed dithranol formulation is easier to be manufactured, its quality will be less depending on the pharmacist’s experience and equipment, and so more reliable. Besides, it will be less expensive to prepare. We advise to use this formulation for short-contact treatment.

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.…”

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].…”

Novel drug delivery systems in topical treatment of psoriasis: Rigors and vigors

“…Various efforts like chemical modifications of the molecule, formulation changes, new treatment modifications or strategies and other miscellaneous approaches like short-contact therapy did not provide any definite solution. [68][69][70] Subsequent work on liposomal systems with dithranol led to the improvement in its skin penetration. [71] Agarwal et al developed dithranol entrapped in liposomal and niosomal vesicles (0.5%) and found both of them superior to conventional formulation, while liposomes showed better results than niosomes employing mice skin.…”

“…[94][95][96][97][98] Only preclinical animal studies with liposomes and nanoparticles of tacrolimus have been reported with improved skin transport effect. [69][70] Theophylline derivatives Dyphylline, a derivative of theophylline, inactivates cyclic AMP (cAMP), and is, therefore, used in the management of psoriasis. [99] Touitou et al (1992) reported significant increase in permeation of dyphylline across abdominal mice skin using liposomal systems, thus corroborating its promise in topical delivery.…”