Researchers suggest a short-term application of topical corticosteroids and maintenance with a less potent agent for patients with intertriginous psoriasis (IP), according to a study published in the September issue of Archives of Dermatology, one of the JAMA/Archives journals.
Psoriasis is an inflammatory skin disease. In a subset of patients, psoriasis is located in the intertriginous areas, including the skin folds of the underarms, breasts, groin, buttocks and genitals, according to background information in the article. "Patients who exhibit intertriginous psoriasis often complain about intense itching, irritation from sweating and soreness. These symptoms may have devastating psychological and emotional consequences." Management of IP usually includes the application of topical corticosteroids, but those medications have adverse effects with long-term use.
In this study, Alexander Kreuter, M.D, from Ruhr University of Bochum, Germany, and colleagues conducted a randomized controlled trial that compared 1 percent pimecrolimus (a new anti-inflammatory drug), 0.005 percent calcipotriol, 0.1 percent betamethasone and the vehicle (a similarly appearing cream with no active drug) in the treatment of IP with a four-week treatment period and a six-week follow-up without therapy. A total of 80 adult patients with the clinical diagnosis of IP were included, 20 patients in each of the four treatment groups.
"After four weeks of treatment, the three active compounds and the vehicle resulted in a significant decrease in mean (average) M-PASI score [Modified Psoriasis Area and Severity Index] (86.4 percent for 0.1 percent betamethasone, 62.4 percent for 0.005 percent calcipotriol, 39.7 percent for 1 percent pimecrolimus and 21.1 percent for vehicle)," the researchers found. "The 0.1 percent betamethasone was significantly more effective than 1 percent pimecrolimus during the study period." The researchers report 25 percent of patients treated with pimecrolimus reported an increase in itching and burning shortly after application, however, most reactions lasted less than 30 minutes and resolved in a few days.
"In conclusion, this study indicated the efficacy of all three active compounds, 1 percent pimecrolimus, 0.1 percent betamethasone, and 0.005 percent calcipotriol (as well as the vehicle) in the treatment of IP. The 0.1 percent betamethasone was clearly more effective than 1 percent pimecrolimus, confirming that treatment with corticosteroids is still the most effective topical approach for psoriasis. However, their use in long-term management, particularly for the treatment of intertriginous areas, which are more prone to steroid adverse effects, is limited. To combine the rapid anti-inflammatory effects of a topical corticosteroid with the favorable long-term effects and safety profile of pimecrolimus or calcipotriol, short-term application of topical corticosteroids for acute disease followed by maintenance treatment with one of these agents seems to be a reasonable approach in the treatment of IP."
(Arch Dermatol. 2006:142:1138-1143. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: Co-author Dr. Bräutigam is an employee of Novartis Pharma GmbH. This study was supported by a financial grant from Novartis Pharma GmbH. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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