Treatment Of Scalp Psoriasis Research Articles

Clinical and Videodermoscopic Evaluation of the Efficacy, Safety, and Tolerability of a Shampoo Containing Ichthyol, Zanthalene, Mandelic Acid, and Honey in the Treatment of Scalp Psoriasis

Purpose of the Study: The aim of the present prospective multicenter open study was to clinically and instrumentally evaluate the efficacy, safety, and tolerability of a shampoo, Mellis Cap® shampoo, containing ichthyol, zanthalene, mandelic acid, and honeydew honey in the treatment of mild to moderate scalp psoriasis. Procedures: Thirty subjects with mild to moderate psoriasis applied the shampoo three times a week for 12 weeks. The outcome was evaluated at 30 days (T1), 60 days (T2), and 90 days (T3) of treatment, comparing it to baseline (T0) by means of clinical and patients’ evaluation, digital photographs, and videodermoscopy. Results: Clinical and patients’ evaluation showed improvement of scalp psoriasis and itching. This was confirmed by videodermoscopy analysis with a significant reduction of scalp psoriasis severity at T2 and T3 compared to baseline. No side effects were observed or reported. Conclusions: Study treatment was well tolerated and showed significant clinical and instrumental improvement of scalp psoriasis. Mellis Cap® shampoo is a good alternative to other medicated shampoos in the treatment of mild to moderate scalp psoriasis.

Prolonged skin retention of clobetasol propionate by bio-based microemulsions: a potential tool for scalp psoriasis treatment

Novel effective and cosmetically acceptable formulations are needed for the treatment of scalp psoriasis, due to the poor efficacy of the current products. The challenge in developing safe, efficient, and convenient delivery systems for this drug was addressed in the present work by formulating clobetasol propionate-loaded W/O microemulsions (MEs). Pseudo-ternary phase diagrams were constructed by using a combination of biocompatible and biodegradable excipients. Characterization studies demonstrated that selected MEs had suitable technological features such as being Newtonian fluids, possessing low viscosity, and high thermodynamic stability. Photomicrographs showed a significant alteration of the skin structure after treatment with MEs, and a preferential concentration of these in the stratum corneum and epidermis. These data, together with ex vivo permeation results, suggested an enhanced topical targeted effect due to an increased drug retention efficacy in the upper skin layers, as desired. Moreover, the bio-based excipients selected could contribute to the healing of the psoriatic scalp. In this way, the improvement of clobetasol efficacy is combined with the useful properties of the microemulsion components and with environmental safety.

The efficacy of short-term clobetasol lotion in the treatment of scalp psoriasis

Background: Scalp psoriasis can have a considerable impact on patients’ quality of life and is considered difficult to treat. Treatment failure may, however, be due to poor adherence, as application of topical treatments to hair bearing areas is difficult and time consuming and also poor communication between physician and patient.Objective: To assess the efficacy of short-term treatment of scalp psoriasis with topical clobetasol lotion.Materials and methods: Twelve patients with mild to severe scalp psoriasis were recruited for this study. Patients applied clobetasol 0.05% lotion twice daily for seven days. They were followed up with phone calls three days after starting the treatment. Skin hydration, transepidermal water loss (TEWL) and skin erythema were assessed noninvasively at baseline and end of study.Results: One week after treatment, median PSI score decreased significantly (p = .002). There was also a significant decrease in median TEWL (p = .012) and increase in skin hydration one week after treatment (p = .010). Eighty three percent of patients were satisfied with treatment result and felt convenient with applying clobetasol lotion.Limitations: Lack of a long-term follow-up.Conclusions: Psoriasis is a long-term disease, and improving adherence in the short time could improve patient’s adherence to treatment in long time.

Léčba psoriázy ve kštici clobetasolem v pěně

Léčba psoriázy ve kštici clobetasolem v pěně

Sustained response with ixekizumab treatment of moderate-to-severe psoriasis with scalp involvement: results from three phase 3 trials (UNCOVER-1, UNCOVER-2, UNCOVER-3)

Background: Scalp is a frequently affected and difficult-to-treat area in psoriasis patients.Objective: We assessed the efficacy of ixekizumab in the treatment of patients with scalp psoriasis over 60 weeks using the Psoriasis Scalp Severity Index (PSSI).Methods: In three Phase 3, multicenter, double-blind, placebo-controlled trials, patients with moderate-to-severe psoriasis in UNCOVER-1 (N = 1296), UNCOVER-2 (N = 1224) and UNCOVER-3 (N = 1346) were randomized to subcutaneous 80 mg ixekizumab every two weeks (Q2W) or every four weeks (Q4W) after a 160 mg starting dose, or placebo through Week 12. Additional UNCOVER-2 and UNCOVER-3 cohorts were randomized to 50 mg bi-weekly etanercept through Week 12. Patients entering the open-label long-term extension (LTE) (UNCOVER-3) received ixekizumab Q4W; UNCOVER-1 and UNCOVER-2 included a blinded maintenance period in which static physician global assessment (sPGA) 0/1 responders were re-randomized to placebo, ixekizumab Q4W, or 80 mg ixekizumab every 12 weeks (Q12W) through Week 60.Results: In patients with moderate-to-severe psoriasis with baseline scalp involvement, PSSI 90 and 100 were achieved at Week 12 in higher percentages of patients treated with ixekizumab Q2W (81.7% and 74.6%) or ixekizumab Q4W (75.6% and 68.9%) compared with patients treated with placebo (7.6% and 6.7%; p < .001 each ixekizumab arm versus placebo) or etanercept (55.5% and 48.1%; p < .001 each ixekizumab arm versus etanercept). These outcomes were maintained through Week 60 of the maintenance (UNCOVER-1 and UNCOVER-2) and LTE (UNCOVER-3) period in patients who continued on ixekizumab Q4W.Conclusion: Ixekizumab was efficacious in treating scalp psoriasis in patients with moderate-to-severe psoriasis, with most patients achieving complete or near-complete resolution of scalp psoriasis and maintaining this response over 60 weeks.

Topical treatments for scalp psoriasis: summary of a Cochrane Systematic Review.

People with chronic plaque psoriasis often have lesions on the scalp that are difficult to treat. This report is a summary of a Cochrane review on the efficacy and safety of topical treatments for scalp psoriasis. For quality-of-evidence assessment, we used the Grading of Recommendations Assessment, Development and Evaluation Working Group approach. Only randomized controlled trials (RCTs) were eligible for inclusion. We searched the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase and LILACS; ongoing trials; indexes of included studies and screened abstracts of six psoriasis-specific conferences up to August 2015. We included 59 RCTs, with 11 561 participants overall. Most findings were limited to short-term treatments (< 6 months). According to the clinician and patients' self-assessment, a corticosteroid-vitamin D combination (e.g. betamethasone dipropionate plus calcipotriol) and corticosteroids of high and very high potency were better than vitamin D. The two-compound combination was superior to the corticosteroid alone, but the additional benefit was small. Reporting of quality-of-life data was insufficient. The two-compound combination and corticosteroids caused fewer withdrawals due to adverse events than vitamin D. There was no difference between the two-compound combination and corticosteroid monotherapy concerning this outcome. Overall the evidence was of moderate quality. Evaluation of other topical treatments was limited. Given the comparable safety profile and only slim benefit of the two-compound combination over the corticosteroid alone, monotherapy with generic topical corticosteroids of high and very high potency may be fully acceptable for short-term therapy. More quality-of-life data and long-term assessments are needed.

Calcipotriene and betamethasone dipropionate for the topical treatment of plaque psoriasis

ABSTRACTIntroduction: Psoriasis affects an estimated 2% of the world's population, with higher rates in developed countries. 80% have mild-to-moderate disease and 50 to 80% have scalp involvement. Topical treatments are the mainstay of treatment.Areas covered: Two-compound calcipotriene and betamethasone dipropionate (BD) is a common topical combination therapy consisting of a vitamin D analogue and a corticosteroid. It comes in ointment, gel/suspension, and foam formulations. Phase II and III clinical trials have consistently shown the two-compound formulation to be effective and safe, with no clinically significant skin atrophy, calcium level changes, or adrenal suppression were seen. Topical scalp solution was also safe and effective in treating scalp psoriasis in pediatric populations.Expert commentary: Calcipotriene plus BD is more effective and safer than the individual ingredients in the same vehicle for treating body and scalp psoriasis. It should be considered a first line therapy for mild-to-moderate plaque psoriasis.

Topical treatments for scalp psoriasis.

Topical treatments for scalp psoriasis.

Topical treatments for scalp psoriasis: evidence‐based guide

Scalp psoriasis can significantly affect quality of life and its treatment presents unique challenges. This article provides an overview of the evidence‐based management of scalp psoriasis in primary care, with an emphasis on topical treatments.

Topical treatment for scalp psoriasis: Comparison of patient preference, quality of life and efficacy for non-alcoholic mometasone emulsion versus calcipotriol/betamethasone gel in daily clinical practice

Objective: To evaluate patients’ assessment of therapy, efficacy, quality of life and treatment adherence in patients with scalp psoriasis treated with non-alcoholic mometasone emulsion or calcipotriol/betamethasone gel. Methods: Prospective, open-label, multicentre, non-interventional study. Patients with non-severe scalp psoriasis were treated with mometasone emulsion or calcipotriol/betamethasone gel. Evaluations included patient’s global assessment of treatment, physician’s global assessment of disease severity, quality of life (Dermatology Life Quality Index), physician’s subjective evaluation of therapy, treatment adherence and adverse events. Results: Ninety-five patients treated with mometasone emulsion and 88 treated with calcipotriol/betamethasone gel were included in the intention-to-treat analysis. Patients’ global assessment of treatment favoured mometasone emulsion over calcipotriol/betamethasone gel (p = 0.008), with treatment rated as good/very good by 91% versus 82.5%. Patients were less likely to report irritation of fingers’ skin with mometasone than with calcipotriol/betamethasone (p = 0.0015). Severity of scalp psoriasis and quality of life improved in both groups. Adherence to treatment was similar in both groups. Physicians’ perception of efficacy, tolerability and compliance was better for mometasone emulsion. Conclusion: Non-alcoholic mometasone emulsion achieved greater acceptability to patients and physicians than calcipotriol/betamethasone gel for the treatment of scalp psoriasis. Both topical treatments were similarly effective in terms of disease severity and quality of life.

Patient-centered outcomes trial of anthralin microcrystalline encapsulated shampoo for treatment of scalp psoriasis

Patient-centered outcomes trial of anthralin microcrystalline encapsulated shampoo for treatment of scalp psoriasis

Scalp Psoriasis: Systematic Review Comparing Topical Treatments and Placebo

Patients with scalp psoriasis suffered from a lower quality of life relating to the highly visible site of their psoriatic lesions. In consequence this fact stimulates investigations involving treatments of this dermatologic disease. The aim of this review is to evaluate the topical treatments for scalp psoriasis compared with placebos. Methods: A systematic review was performed using searches in the database LILACS, MEDLINE, Cochrane Library, and Embase. As selection criteria were chosen eligible publications involving randomized controlled trials, patients with scalp psoriasis diagnosed clinically or by biopsy, interventions with topical treatments for scalp psoriasis compared with placebo. Outcome related to the reduction in severity of psoriasis of the scalp, assessed by physicians and patients, and assessment of adverse effects that required discontinuation of treatment. The results have shown that the patients were aged 12 to 97 years, including 3441 patients. Ten of the fifteen studies included reported gender data. Patients were mostly female. Twelve studies were about psoriasis’s severity. These studies in which the severity has been described, the classification of severity was mild (0 study), mild to moderate (1 study), moderate to severe (11 studies) and severe (0 study). In conclusion, topical corticosteroids, calcipotriol, ciclopirox olamine and associations between them are effective in the treatment of scalp psoriasis. Clobetasol propionate (0.05%) was the most effective active ingredient in several vehicles in the induction treatment of scalp psoriasis.

Are topical keratolytic agents needed in the treatment of scalp psoriasis?

Topical corticosteroids are the primary treatment for scalp psoriasis. Keratolytic agents are promoted as adjunctive treatments. However, complex treatment regimens may result in poor adherence and outcomes. To evaluate the evidence for the need for use of topical keratolytic agents as opposed to topical corticosteroid monotherapy in the treatment of scalp psoriasis. A review of the literature was performed seeking clinical trials using topical keratolytics, topical corticosteroids or the combination for treatment of scalp psoriasis. Complete clearance of scalp psoriasis can be achieved in 10-78% of patients using topical corticosteroids alone, in 3% of patients using topical keratolytics alone, and in up to 84% using a combination of topical keratolytics and topical steroids. Clinical trials comparing the combination of keratolytics and topical corticosteroids versus topical corticosteroids alone found marginally more efficacy using combination regimens. We could not find any long term study evaluating the efficacy of combination therapy in scalp psoriasis and its effect on the patients' adherence. High potency topical corticosteroids are usually effective in treating scalp psoriasis in clinical trials. Poor efficacy in clinical practice may be owing to poor adherence to the treatment regimen. Using a keratolytic agent in conjunction with a topical corticosteroid may provide marginal additional benefit in clinical trials, but that benefit is likely outweighed by the downside of complicating treatment and reducing adherence in the clinical setting, unless a single product containing both medications were used.

Efficacy and maintenance strategies of two-compound formulation calcipotriol and betamethasone dipropionate gel (Xamiol® gel) in the treatment of scalp psoriasis: results from a study in 885 patients

Background: Previous studies showed the efficacy of a formulation containing calcipotriol and betamethasone dipropionate for the treatment of psoriasis. Objective: To investigate maintenance strategies of a formulation containing calcipotriol (50 µg/g) and betamethasone dipropionate (0.5 mg/g) for the treatment of scalp psoriasis. Materials and methods: Nine-hundred and four patients were screened and randomised on a 1:1 basis in two groups: maintenance of two applications per week (group A) versus on-demand therapy (group B). Clinical evaluation was performed at weeks 0, 2, 4, 8 and 12. Results: Eight-hundred and eighty-five patients were randomised: 441 in group A and 444 in group B. From week 2, both groups showed a significant clinical improvement compared with baseline; at weeks 8 and 12, group A demonstrated a higher clinical response compared with group B (p < 0.05). This difference was statistically significant (OR 0.47, 95% CI 0.37, 0.60). Conclusions: The maintenance of twice-weekly application versus on-demand treatment of calcipotriol/betamethasone dipropionate gel is more effective and is associated with a lower rate of relapse.

Long-term management of scalp psoriasis: perspectives from the international psoriasis council

The scalp is a well-known predilection site for psoriasis. Epidemiological data on the various manifestations of scalp psoriasis as well as on its therapeutic management are sparse. The understanding of the natural course of scalp psoriasis is relevant for its therapeutic management. In over 25% of patients, scalp psoriasis is the first signal of the psoriatic condition. Nevertheless, few of the therapies currently used for the treatment of scalp psoriasis have been evaluated for efficacy in the setting of well-designed, well-controlled clinical studies. The lack of comparative data impedes the interpretation of the results from studies of scalp psoriasis. Long-term studies of the efficacy and safety of scalp treatments are lacking. Moreover, clinical studies generally do not incorporate quality of life impact or mechanisms to enhance adherence thus hindering the optimal management of the patient over the long-term. Consequently, this report will evaluate the available data and the associated factors to be considered in the development of a treatment paradigm for the long-term management of the scalp psoriasis patient.

Use of a psoriasis plaque test in the development of a gel formulation of calcipotriol and betamethasone dipropionate for scalp psoriasis

Background: The efficacy and safety of calcipotriol plus betamethasone dipropionate ointment in the treatment of psoriasis vulgaris has consistently been demonstrated in several clinical trials. For treatment of scalp psoriasis, more convenient formulations are required. Therefore, new lipophilic alcohol-free gel formulations containing calcipotriol (50 µg/g) and betamethasone (0.5 mg/g; as dipropionate) (two-compound gels) for treatment of scalp psoriasis were developed. Objective: To identify the optimal gel formulation by evaluating the antipsoriatic effect in a psoriasis plaque test model. Method: The use of a psoriasis plaque test enables investigation of the antipsoriatic effect of several formulations and compounds in a limited number of patients, and is a useful method for predicting treatment efficacy in psoriasis vulgaris. Five different gel vehicles were investigated in two plaque test studies. Results and conclusion: The optimised two-compound gels showed superior antipsoriatic effect over marketed betamethasone dipropionate solution. The results suggest that use of the psoriasis plaque test early in the development process can improve the development of topical formulations for dermatological use and can be a beneficial tool for selecting the most promising formulations for further clinical studies in psoriasis vulgaris.

Spotlight on Calcipotriene/Betamethasone Dipropionate in Psoriasis Vulgaris of the Trunk, Limbs, and Scalp†

Calcipotriene (calcipotriol)/betamethasone dipropionate (calcipotriene 50 μg/g and betamethasone 0.5 mg/g) is a fixed-dose combination of a vitamin D3 analog and a corticosteroid indicated for the once-daily, topical treatment of psoriasis vulgaris of the trunk, limbs, and scalp in adults. Both the ointment (Daivobet®; Dovobet®) and gel (Xamiol®; Daivobet® Gel; Dovobet® Gel) formulations of calcipotriene/betamethasone dipropionate can be used to treat psoriasis vulgaris of the trunk and/or limbs, although the gel formulation was specifically developed for the treatment of scalp psoriasis. This article reviews the efficacy and tolerability of calcipotriene/betamethasone dipropionate in patients with psoriasis vulgaris, as well as summarizing its pharmacologic properties. Calcipotriene/betamethasone dipropionate has low systemic absorption and displays local anti-inflammatory and immunoregulatory properties. It reduces the hyperproliferation of keratinocytes and helps normalize keratinocyte differentiation. In large, well designed clinical trials, calcipotriene/betamethasone dipropionate, either as the ointment or the gel formulation, applied once daily for 4-8 weeks, was more effective than placebo, calcipotriene, or tacalcitol, as well as betamethasone dipropionate in most instances, for the topical, symptomatic treatment of psoriasis vulgaris of the trunk/limbs. Likewise, calcipotriene/betamethasone dipropionate gel applied once daily for 8 weeks was more effective than placebo or either component alone in the topical, symptomatic treatment of psoriasis vulgaris of the scalp. Long-term, once-daily, when required therapy with calcipotriene/betamethasone dipropionate for 52 weeks was more effective than calcipotriene alone for the treatment of scalp psoriasis, and was at least as effective as switching to calcipotriene for 48 weeks after 4 weeks of calcipotriene/betamethasone dipropionate or alternating between calcipotriene/betamethasone dipropionate and calcipotriene every 4 weeks for 52 weeks in the treatment of psoriasis vulgaris of the trunk/limbs. Calcipotriene/betamethasone dipropionate also improved health-related quality of life. Calcipotriene/betamethasone dipropionate was generally well tolerated, with most adverse drug reactions being lesional or perilesional effects of mild or moderate severity. Calcipotriene/betamethasone dipropionate was often associated with fewer lesional/perilesional adverse reactions than calcipotriene or tacalcitol and did not appear to be associated with a higher incidence of corticosteroid-related adverse events during long-term therapy. Pharmacoeconomic analyses predicted calcipotriene/betamethasone dipropionate to be more cost effective than other topical therapies. Thus, calcipotriene/betamethasone dipropionate is an important, effective, once-daily, topical therapy for the symptomatic treatment of psoriasis vulgaris of the trunk, limbs, and scalp.

Novel stain‐free lecithinized coal tar formulation for psoriasis

Coal tar has been a very popular traditional treatment for various types of psoriasis for over a century. It is the first-line treatment for scalp, hand, and foot psoriasis. However, the application of coal tar on hair invariably causes staining, which results in a high degree of patient non-compliance, especially in patients with non-black hair. Thus, the treatment of scalp psoriasis with a topical coal tar formulation requires that special concern be paid to product esthetics. This study aimed to evaluate the hair-staining characteristics of a novel lecithinized coal tar (LCT) formulation on different types of mammalian hair. Samples of hair from different mammals, including human, sheep, rabbit, and goat, were repeatedly exposed to the LCT formulation over 14 days. The color of hair samples treated with LCT was compared with that of untreated control hair samples. The study revealed the distinct non-staining potential of the LCT formulation. This LCT formulation lacks the propensity to stain hair and thus has excellent potential to be exploited in the treatment of scalp psoriasis.

Calcipotriol/Betamethasone Dipropionate

Calcipotriol/betamethasone dipropionate (calcipotriol 50 μg/g and betamethasone 0.5 mg/g) is a fixed-dose combination of a vitamin D(3) analogue and a corticosteroid indicated for the once-daily, topical treatment of psoriasis vulgaris of the trunk, limbs and scalp in adults. Both the ointment (Daivobet®; Dovobet®) and gel (Xamiol®; Daivobet® Gel; Dovobet® Gel) formulations of calcipotriol/betamethasone dipropionate can be used to treat psoriasis vulgaris of the trunk and/or limbs, although the gel formulation was specifically developed for the treatment of scalp psoriasis. This article reviews the efficacy and tolerability of calcipotriol/betamethasone dipropionate in patients with psoriasis vulgaris, as well as summarizing its pharmacological properties. Calcipotriol/betamethasone dipropionate has low systemic absorption and displays local anti-inflammatory and immunoregulatory properties. It reduces the hyperproliferation of keratinocytes and helps normalize keratinocyte differentiation. In large, well designed clinical trials, calcipotriol/betamethasone dipropionate, either as the ointment or the gel formulation, applied once daily for 4-8 weeks, was more effective than placebo, calcipotriol and tacalcitol, as well as betamethasone dipropionate in most instances, for the topical, symptomatic treatment of psoriasis vulgaris of the trunk/limbs. Likewise, calcipotriol/betamethasone dipropionate gel applied once daily for 8 weeks was more effective than placebo or either component alone in the topical, symptomatic treatment of psoriasis vulgaris of the scalp. Long-term, once-daily, when required therapy with calcipotriol/betamethasone dipropionate for 52 weeks was more effective than calcipotriol alone for the treatment of scalp psoriasis, and was at least as effective as switching to calcipotriol for 48 weeks after 4 weeks of calcipotriol/betamethasone dipropionate or alternating between calcipotriol/betamethasone dipropionate and calcipotriol every 4 weeks for 52 weeks in the treatment of psoriasis vulgaris of the trunk/limbs. Calcipotriol/betamethasone dipropionate also improved health-related quality of life. Calcipotriol/betamethasone dipropionate was generally well tolerated, with most adverse drug reactions being lesional or perilesional effects of mild or moderate severity. Calcipotriol/betamethasone dipropionate was often associated with fewer lesional/perilesional adverse reactions than calcipotriol or tacalcitol and did not appear to be associated with a higher incidence of corticosteroid-related adverse events during long-term therapy. Pharmacoeconomic analyses predicted calcipotriol/betamethasone dipropionate to be more cost effective than other topical therapies. Thus, calcipotriol/betamethasone dipropionate is an important, effective, once-daily, topical therapy for the symptomatic treatment of psoriasis vulgaris of the trunk, limbs and scalp.

Treatment of scalp psoriasis with clobetasol-17 propionate 0.05% shampoo: a study on daily clinical practice

Treatment of scalp psoriasis with clobetasol-17 propionate 0.05% shampoo: a study on daily clinical practice