The psoriatic patient and the use of topical antipsoriatics

Abstract

Psoriasis is a chronic disease with profound social implications. When patients are asked about the worst aspect of having psoriasis, most of them answer that it is the appearance and consequent embarrassment. Dermatological diseases all have a strong impact on the patient's psyche because of their visibility. The onset of psoriasis in childhood or adolescence can magnify the psychological aspects of the disease. Attempts have been made to quantify stress and to identify its relationship to skin disease. Although studies on the relationship between stress and psoriasis are often at variance, there seems to be a subgroup of patients in whom stress is a precipitating factor. Psoriasis for most patients requires regular treatment. There are types of the disease which respond very well to certain treatments with long-term remission. However, psoriasis is a disease which can be koebnerized by internal and external triggers, may vary in its life cycle and may relapse frequently. There are still disadvantages with all available therapies. They may have serious side-effects during or after treatment or the treatment protocol may be difficult to follow. Treatments such as short-contact dithranol, ultraviolet (UV) A/B radiation and psoralen/UVA (PUVA) are either difficult to use at home or require special equipment and experienced personnel. In general, severe psoriasis requires the facilities of a hospital or a daycare clinic. However, mild psoriasis mostly does not need these specialist facilities. The patient is able to perform the treatment at home. In the last 5 years psoriatic patients have experienced a marked increase in their quality of life as a result of the introduction of balneophototherapy, bath PUVA and, in particular, new topical treatments with vitamin D3 derivatives (calcipotriol, tacalcitol) and very recently a topical retinoid. Combination of the topical agents with other treatment modalities such as UVA/B, bath-PUVA or balneophototherapy can increase efficacy by lowering the side-effects and shortening the treatment time. A treatment with tacalcitol, for example, once daily significantly decreases the time needed for selfcare at home. In a very recent nonrandomized study, 5205 patients with mild to moderate psoriasis were treated with tacalcitol once daily alone or in combination with UV or other treatments. Over 90% showed a good to very good compliance and reported very good to good local tolerability. More than 80% of the patients improved markedly during a treatment course of 8-12 weeks. Systemic adverse events such as an increase in plasma calcium could not be detected.