Treatment of Psoriasis Vulgaris with Calcipotriol Betamethasone Dipropionate Combination Followed by Calcipotriol and Assessment of the Adjuvant Basic Use of Urea-Based Emollients

Abstract

A new combination product containing betamethasone dipropionate and calcipotriol (Dovebet" ointment) has been proven very effective and well tolerated in patients with psoriasis vulgaris. Emollients are adjunctive modalities commonly used in psoriasis; however, their actual role in combination with topical drugs as well as well as their compatibility with these drugs have not been well elucidated. In 313 adult patients with psoriasis vulgaris, we studied the efficacy and tolerability of treatment with Dovobet" ointment combined with urea-based emollients (Excipial U®) for 4 weeks, followed by treatment with calcipotriol (Daivonex") either alone (group A) or combined with urea-containing emollients (Excipial U®, group B) for 8 weeks. Clinical evaluations were performed at baseline, at 4 and 12 weeks, assessing the clinical score for erythema, scaling, infIltration and pruritus, graded on the basis of a 5-point scale. After the initial 4-week treatment, a significant improvement of all clinical parameters was observed (p<O.05). Overall, clinical results improved further during the maintenance treatment phase; significant changes (p<O.05) were observed in each group. Most patients considered treatment efficacy positively at both 4 weeks and 12 weeks. Interestingly, at the end of the study, a greater percentage of patients in group B than in group A judged the efficacy as excellent. Treatment was very well tolerated. Only two patients complained of mild and transient burning sensation during the first days of treatment. The results of this study confirm the great efficacy and tolerability of sequential treatment with Dovobet", and Daivonex" in psoriasis vulgaris and show the enhanced acceptability of this treatment associated with urea-based emollients.Corticosteroids and calcipotriol, a synthetic analogue of 1,25-dihydroxyvitamin D3, are widely used topical treatments for psoriasis and have been used separately for many years to treat this skin disorder.Both corticosteroids and calcipotriol affect at variable degree inflammatory processes and keratinocyte differentiation and proliferation, but their mechanisms of action are quite different (1-4).

Efficacy and safety of combinations of first‐line topical treatments in chronic plaque psoriasis: a systematic literature review

“…Database research revealed 66 publications 7–72 on the combined use of corticosteroids and vitamin D analogues in chronic plaque psoriasis. Thirty studies were excluded because of various reasons: 10 studies were excluded because outcome reports also included systemic treatments or involved other types of psoriasis, 7–16 eight studies because outcome measures were not described or outcomes were not recorded as absolute numbers, 17–24 five because the treatment regimen was unclear, 25–29 four because the papers did not reveal original data, 30–33 two because demographic data were not described, 34,35 and one study because of inconsistent data 36 . Eight of the 36 included studies concern scalp psoriasis and will be discussed separately.…”

Treatment of Mild to Moderate Plaque Psoriasis with Calcitriol Ointment Applied with or without a Dosing Device

“…However, the dosing method in our study was well accepted by patients. Another consideration derived from our results is that calcitriol ointment can be safely combined to background treatment with urea-based emollients which can in tum enhance the activity of drugs in psoriasis acting as 'therapeutic moisturizers' (24).…”

Keratolytics and Emollients and Their Role in the Therapy of Psoriasis: a Systematic Review

“…However, the percentage of affected area was not influenced [ 42 ]. From three small studies, limited evidence is known for an enhanced efficacy of other topical agents such as bifonazole, dithranol or betamethasone dipropionate and calcipotriol leading to a shortened treatment duration (see Table 3 ) [ 43 – 45 ]. In the evaluated clinical studies, a burning sensation was observed in three patients (see Table 3 ) [ 39 , 42 ].…”