Calcipotriol (Dovonex) scalp solution in the treatment of scalp psoriasis: comparative efficacy with 1% coal tar/1% coconut oil/0.5% salicylic acid (Capasal) shampoo, and long-term experience

Abstract

INTRODUCTION: Up to 40% of patients with psoriasis suffer from involvement of the scalp, with flaking skin or secondary hair loss. Treatment of the scalp is problematic owing to the hair limiting topical or UV light therapy and because of the close proximity of particularly sensitive facial skin. Moreover, some treatments are inconvenient and difficult to apply. OBJECTIVE: To evaluate the efficacy, safety and tolerability of calcipotriol scalp solution compared with a coal tar-based shampoo over an 8-week treatment period, and to assess response to calcipotriol only over a continued 16-week period. METHODS: The comparative efficacy, safety and tolerability of up to 8 weeks' treatment with calcipotriol scalp solution (50 mug/ml) (n=238) and 1% coal tar/1% coconut oil/0.5% salicylic acid shampoo (n=237) were determined in patients with mild or moderate scalp psoriasis. Additional sites of psoriasis were treated with either calcipotriol ointment or 5% coal tar/2% allantoin/0.5% hydrocortisone cream. RESULTS: A total of 57% of patients receiving calcipotriol scalp solution showed moderate improvement or better compared with 37% of patients treated with coal tar shampoo (odds ratio=3.2 in favour of calcipotriol, 95% confidence interval 2.0–5.2, P<0.001). Patients responding to calcipotriol scalp solution continued long-term treatment for a further 16 weeks and showed improvement over this period (P<0.001). Although a higher incidence of adverse events was reported in the calcipotriol group (137 out of 230 patients) than in those receiving coal tar (77 out of 215 patients), these were predominantly local skin irritation occurring early in treatment. No changes were found in calcium levels in patients who used calcipotriol scalp solution concurrently with calcipotriol ointment. CONCLUSION: Calcipotriol scalp solution is more effective than a coal tar-based shampoo and shows continued efficacy and good tolerability with long-term use. (J Dermatol Treat (2000) 11:21–28)