Clobetasol propionate followed by calcipotriol is superior to calcipotriol alone in topical treatment of psoriasis.
BACKGROUND
Although potent, topical corticosteroids offer effective and rapid healing of psoriatic lesions. Their long term use is limited because of the risk of side effects. Calcipotriol is safe for long-term treatment, but its initial efficacy is lower than with topical corticosteroids.


OBJECTIVE
To investigate whether 2 weeks of treatment with clobetasol propionate 0.05% ointment bd followed by 4 weeks of treatment with calcipotriol 50 microg/g bd would offer therapeutic advantages over 6 weeks of continuous treatment with calcipotriol.


METHODS
Forty-nine patients with moderate to severe plaque psoriasis were recruited from five centres in Norway. In a randomised, double-blind, right- versus left-side comparison, ointments were applied to two symmetrically-located areas.


RESULTS
Two weeks of treatment with clobetasol propionate produced a significantly greater decrease in total symptom score (combined scores of erythema, induration and scaling) than calcipotriol treatment (P < 0.0001). This improvement on the clobetasol propionate-treated side of the body was maintained throughout a subsequent 4-week treatment period when calcipotriol was applied to both sides of the body (P < 0.0001). The superiority of the clobetasol propionate followed by calcipotriol treatment was maintained during a 4-week, treatment-free, observation period. Treatments were well tolerated with no rebound effect.


CONCLUSIONS
Clobetasol propionate ointment bd for 2 weeks followed by treatment with calcipotriol ointment bd for 4 weeks was superior to calcipotriol ointment alone in the treatment of plaque psoriasis.
Austad
J
J
Sandvika Bad, Norway.
Bjerke
J R
JR
Gjertsen
B T
BT
Helland
S
S
Livden
J K
JK
Morken
T
T
Mørk
N J
NJ
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002117:Calcitriol / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002990:Clobetasol / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017453:Dermatitis, Irritant / Q000209:etiology; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010819:Physician's Role; D015397:Program Evaluation; D011537:Pruritus / Q000139:chemically induced; D011565:Psoriasis / Q000188:drug therapy*; D011693:Purpura / Q000139:chemically induced; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects / Q000473:pathology; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D003879:Dermatologic Agents; D005938:Glucocorticoids; C055085:calcipotriene; D002990:Clobetasol; D002117:Calcitriol