Calcipotriol 50micrograms/g / Betamethasone dipropionate 500micrograms/g foam

Vitiligo is a depigmentation disorder whose treatment remains a serious challenge. While it is generally accepted that topicals and phototherapy are helpful for generalized symmetric disease, randomized controlled trials (RCTs) provide the best evidence for treatment. Our objective was to identify and summarize RCTs for vitiligo from 2013 to 2023. A systematic review registered with the International Prospective Register of Systematic Reviews (PROSPERO) was performed per PRISMA guidelines. We searched CENTRAL, ClinicalTrials.gov, Embase, PubMed, and Web of Science for RCTs using keywords such as 'vitiligo' and/or 'treatment' or 'intervention.' A total of 652 studies underwent full-text review, and 151 studies met the inclusion criteria. We focused our study on RCTs using the vitiligo area scoring index (VASI) as the primary outcome measure, leading to 36 studies. We further narrowed our focus to studies that could be aggregated into the intervention categories: phototherapy and systemic combination therapy (n=10), topical and topical combination therapy (n=15), and systemic monotherapy (n=5).  Treated versus control subjects showed statistically improved VASI after the following interventions were added to phototherapy: oral psoralen, oral minipulsed prednisone, implanted afamelanotide, topical ethyl vanillate, topical bimatoprost, and oral vitamins A and E. Effective topical therapies were ruxolitinib, calcipotriol and betamethasone, tacrolimus and mometasone, and microdermabrasion and tacrolimus. None of the systemic monotherapies was superior to their corresponding comparator.

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Psoriasis vulgaris has serious co-morbidities and impairs the quality of life. Vitamin D analogues and corticosteroids are widely used for treating psoriasis, but they have numerous effects. This review aims to assess the efficacy and safety of calcipotriol/betamethasone dipropionate (Cal/BD) as an alternative that may enhance patients' adherence. We searched PubMed, Cochrane, Web of science, and Scopus for reliable trials. The analysis was conducted by comprehensive meta-analysis (CMA) software using the Inverse-Variance method. The analysis showed that the fixed Cal/BD combination improves the psoriasis area and severity index score in body lesions (P<0.0001 at weeks one, two, four, and eight). It improves the total sign score (TSS) and achieves TSS-based response in scalp lesions (P<0.01 at eight weeks). Treatment success was achieved according to physician’s global assessment/investigator’s global assessment in scalp lesions (P<0.001 at weeks four, and eight), and according to patient’s global assessment in body (P=0.001 at week four) and scalp lesions (P<0.05 at weekss two, four, and eight). Adverse events were low for body (P<0.05 at weeks four, eight, and twelve) and scalp lesions (P<0.0001 at week eight). Our conclusion is that Cal/BD is effective and well-tolerated alternative therapy for psoriasis vulgaris.

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BackgroundDespite advances in systemic targeted therapies, topical agents remain the primary treatment for localized psoriasis. However, their therapeutic effects are often delayed and unsatisfactory. The dissolving microneedle (DMN) patch, a novel transdermal drug delivery system, enhances the absorption of topical agents through micro-channels.ObjectiveTo evaluate the efficacy of DMN patches in enhancing drug delivery and improving clinical outcomes in psoriatic plaques.MethodsA prospective, randomized, split-body study was conducted to verify the efficacy of additional use of DMN patches after topical agent application in psoriasis treatment. Patients with mild psoriasis were enrolled and 6 paired lesions per patient were randomized into 3 groups: ointment-only, ointment-with-no needle patch, and ointment-with-DMN patch. Lesions were treated with a topical agent (betamethasone and calcipotriol) once daily for 2 weeks. Modified psoriasis area and severity index (mPASI) scores were measured weekly. In vitro and ex vivo experiments were performed to confirm micro-channel formation, microneedle dissolution, and drug penetration enhancement.ResultsA total of 132 paired lesions from 22 patients were analyzed. The ointment-with-DMN patch group showed significantly improved mPASI scores (80.4%±20.5%; 5.42→1.06) compared to the ointment-with-no needle patch (64.6%±33.0%; 4.94→1.68) (ppIn vitro studies demonstrated 2.1-fold enhanced drug delivery with DMN patches, while ex vivo histological analysis confirmed micro-channel formation. No adverse events, including infection or psoriasis exacerbation, were observed.ConclusionThe DMN patch is an effective adjunctive tool that enhances transdermal drug delivery and improves therapeutic outcomes in psoriatic plaques, particularly those refractory to topical agents.Trial registrationClinicalTrials.gov Identifier: NCT02955576.

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Introduction: Nail psoriasis poses a notable challenge due to its significant impact on patient's quality of life and its resistance to traditional treatments. Recent interest has focused on laser therapies, which offer targeted treatment by addressing the underlying inflammatory processes of the disease. This study evaluated the effectiveness and safety of pulsed dye laser (PDL), fractional CO2 laser, and Nd:YAG (neodymium-doped yttrium aluminum garnet) laser for nail psoriasis. Methods: In this randomized clinical trial, 40 patients with mild to moderate bilateral nail psoriasis were enrolled at Razi hospital. The participants were divided into four groups: Nd:YAG laser, PDL, fractional CO2 laser, and a control group treated with calcipotriol/betamethasone ointment. Each received four treatment sessions over four months. The Nail Psoriasis Severity Index (NAPSI) was used to evaluate effectiveness, while pain and satisfaction were assessed using the visual analog scale (VAS). Statistical significance was determined, with PResults: The study found that PDL achieved the highest reduction in NAPSI scores, with a significant 62.4% decrease, followed by a 54.6% decrease with the fractional CO2 laser. In contrast, the Nd:YAG laser achieved a less notable 32.4% improvement, while the ointment control group showed a 15.9% decrease. Pain was least reported in the PDL group, and satisfaction scores were highest among these patients. The PDL and fractional CO2 lasers outperformed both the Nd:YAG laser and the topical therapy in effectiveness and patient comfort. Conclusion: PDL and fractional CO2 laser treatments are superior interventions for managing nail psoriasis, providing a significant improvement in NAPSI scores and better patient experiences compared to the Nd:YAG laser and topical ointment. These findings endorse the inclusion of laser therapy in management plans for nail psoriasis, suggesting further research into optimizing their use and potential combination with other therapies. Trial Registration: https://irct.behdasht.gov.ir/; identifier: IRCT20220723055530N4.

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