This double‐blind randomized study was designed to compare the efficacy and safety of calcipotriol ointment (50 μg/g) with betamethasone dipropionate (64 mg/g) and salicylic acid (0.03 g/g) ointment ...in the treatment of nail bed psoriasis. Fifty‐eight patients applied the given drug to the affected nails twice a day for 3–5 months, depending on clinical response. Efficacy was assessed monthly on the basis of nail thickness, measured in millimetres. Photographs of the treated nails were taken at baseline, and after 3 and 5 months. Tolerability was assessed at 3 and 5 months. In patients with fingernail psoriasis, after 3 months of treatment subungual hyperkeratosis was reduced from 2.3 ± 0.1 mm (mean ± SEM) to 1.5 ± 0.1 mm (−26.5%) in the calcipotriol group and from 2.3 ± 0.1 mm to 1.6 ± 0.1 mm (−30.4%) in the betamethasone dipropionate and salicylic acid group not significant (NS) between treatments, analysis of variance ( ANOVA). After 5 months, responders showed a 49.2% reduction in hyperkeratosis in the calcipotriol group (from 2.8 ± 0.1 mm to 1.4 ± 0.2 mm) and 51.7% (from 2.1 ± 0.1 mm to 1.0 ± 0.1 mm) in the betamethasone dipropionate and salicylic acid group (P < 0.001 from baseline, NS between treatments,
ANOVA). In patients with toenail psoriasis, after 3 months of treatment there was an overall reduction in hyperkeratosis from 2.6 ± 0.1 mm to 2.1 ± 0.1 mm (−20.1%) in the calcipotriol group and from 3.0 ± 0.1 mm to 2.3 ± 0.1 mm (−22.9%) in the betamethasone dipropionate and salicylic acid group (P < 0.001 from baseline, NS between treatments,
ANOVA). By the end of the fifth month there was a 40.7% reduction in hyperkeratosis in the calcipotriol group (from 2.1 ± 0.1 mm to 1.2 ± 0.1 mm) and 51.9% in the betamethasone dipropionate and salicylic acid group (from 2.7 ± 0.1 mm to 1.3 ± 0.1 mm; P < 0.0001 from baseline, NS between treatments,
ANOVA). The results of the study show that calcipotriol is as effective as a combination of a topical steroid with salicylic acid in the treatment of nail psoriasis and represents a safe alternative in the topical treatment of nail psoriasis.
Studies on scalp hair from psoriatic lesions have revealed marked irregularities in the cuticular pattern. The aim of this study was to investigate the incidence of hair shaft disorders in psoriatic ...patients and to evaluate the possibility of a correlation with scalp involvement. We examined hair from 39 psoriatic patients using scanning electron microscopy and compared it with hair from a control group of 12 healthy people. We confined our observations of the hair fibres to the areas nearest the root. Our data confirm previous observations indicating that dystrophic changes in hair cuticle cells occur more often in hairs from both unaffected and affected skin of psoriatic patients compared with normal subjects. No differences were observed between hair shafts taken from affected and unaffected psoriatic areas; cuticular breakage and an abraded cuticular surface were present only in the hair of psoriatic patients.
Calcipotriol is a synthetic analogue of vitamin D, used in the treatment of psoriasis. Until now no specific sid-effects have been described after combined therapy with calcipotriol and UV. We ...describe 3 patients, who in the summer of 1993, after a combined treatment of calcipotriol and heliotherapy, developed hyperpigmentation in the site where the ointment had been applied. Hyperpigmentation healed spontaneously in less than 7 months. To the best of our knowledge there are no other reports of this side-effect due to calcipotriol. In our opinion the fact that the 3 patients presented the hyperpigmentation only on the treated lesions and that, in the past, they had not presented similar lesions after exposure to sunlight confirms the relationship between the hyperpigmentation and the combined treatment used.
There are no previous reports of adverse pulmonary reactions in psoriatic patients treated for a long time with low dosages of methotrexate (MTX). We successfully treated a 57-year-old woman, ...affected with psoriasis and psoriatic arthritis, with 7.5 mg/week MTX for 24 months. One year later the patient herself, without any medical supervision, took 7.5 mg MTX every day instead of once a week, for a period of 15 days, after which she developed a nonproductive cough, increasing dyspnoea and fever. We discontinued MTX and introduced antibiotic therapy. The clinical course was unchanged. Chest radiograph, HRCT, bronchoalveolar lavage and transbronchial biopsy demonstrated haemosiderosis and focal mild fibrosis. The diagnosis was pulmonary adverse reaction to MTX. Corticosteroid therapy was introduced which produced a rapid clinical improvement. We describe this side-effect, never seen before, emphasizing that it occurred as a result of excessiveovertreatment.
Objective
The aim of this study was to evaluate the efficacy and tolerability of the association of calcipotriol ointment (50 μg/g) plus cyclosporine versus cyclosporine alone in the treatment of ...moderate psoriasis (mean PASI: 13).
Methods
Twenty patients were enrolled in this right‐left open study. All the patients admitted were treated with cylosporine at an initial dose of 4.5 mg/kg/day; in case of clinical improvement this dosage was reduced by 0.5 mg/kg/day every 15 days. In each patient we chose two similar, symmetrical lesions and calcipotriol ointment was applied only on the right lesion, twice a day, until the healing of the lesion or for 1 month. Patients were checked at baseline and every 15 days.
Results
Eighteen patients completed the study and 17 of the 18 presented more evident improvement on the side treated with combined therapy, while only one patient showed a better result on the side treated with cyclosporine alone. A significant difference of the total score was already present after 15 days of therapy and was confirmed at the following check‐ups.
Conclusions
These results underline the usefulness of the association of calcipotriol and cyclosporine in order to decrease the total dosage of cyclosporine.
Background Association of different treatments are often used in erythrodermic psoriasis in order to increase the effectiveness and decrease the incidence of side effects due to single drugs.
...Materials and methods Three in-patients affected by erythrodermic psoriasis, not responding to cyclosporine, (two patients) and etretinate, (one patient), were treated with the association cyclosporine plus etretinate.
Results Clinical response was prompt to the combined therapy. The two drugs were tapering off gradually over 6 months; the patients maintained the remission for prolonged period.
Conclusions Combined cyclosporine-etretinate therapy may be considered as an effective and well tolerated treatment of erythrodermic psoriasis in patients not responding to monotherapy regimen.
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