Clobetasol-17 propionate lotion under hydrocolloid dressing (Duoderm ET) once weekly versus unoccluded clobetasol-17-propionate ointment twice daily in psoriasis: an immunohistochemical study on remission and relapse.
It is well established that the efficacy of corticosteroids under occlusion with hydrocolloids (HCD) is superior compared to monotherapy with topical corticosteroids. However, following treatment with more potent corticosteroids, increased side effects and a more pronounced rebound might be expected. In the present clinical study, the efficacy of relapse after and the safety characteristics of two treatment modalities were compared: clobetasol-17-propionate lotion under an HCD dressing once weekly versus clobetasol-17-propionate ointment without an HCD twice daily. Clinical assessments were recorded and skin biopsies were taken before therapy, at clearance and 6 weeks after clearance. A panel of monoclonal antibodies to characterize epidermal proliferation, differentiation and inflammation were selected. In addition, clinical and histological assessments for skin atrophy were made. Both therapies had a major therapeutic effect, which was reflected in the clinical and immunohistochemical parameters. The only difference between the two therapies was a faster remission induction time in patients treated with corticosteroids combined with HCD. Six weeks after discontinuation of treatment, similar clinical and histological signs of relapse were observed for both therapies. Clinically, there were no signs of skin atrophy but histologically, epidermal thinning occurred to the same extent with both therapies but proved to be reversible within 6 weeks of discontinuation of treatment. From this study it can be concluded that the combination of HCD and corticosteroids is able to induce relatively fast remission compared to corticosteroid monotherapy but relapse and safety characteristics are comparable to the unoccluded corticosteroid therapy.
van der Vleuten
C J
CJ
Department of Dermatology, University Hospital Nijmegen, The Netherlands. c.vandervleuten@derma.azn.NL
van Vlijmen-Willems
I M
IM
de Jong
E M
EM
van de Kerkhof
P C
PC
D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D002990:Clobetasol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003102:Colloids; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009779:Occlusive Dressings; D009824:Ointments; D011565:Psoriasis / Q000188:drug therapy* / Q000378:metabolism; D012008:Recurrence; D012074:Remission Induction; D012867:Skin / Q000378:metabolism
D000893:Anti-Inflammatory Agents; D003102:Colloids; D005938:Glucocorticoids; D009824:Ointments; D002990:Clobetasol