title: Topical treatments for chronic plaque psoriasis: an abridged Cochrane systematic review.
abstract: BACKGROUND
  Chronic plaque psoriasis is the most common type of psoriasis and is characterized by redness, thickness, and scaling. First-line management is with topical treatments.
  
  
  OBJECTIVE
  We sought to undertake a Cochrane review of topical treatments for chronic plaque psoriasis.
  
  
  METHODS
  We systematically searched major databases for randomized controlled trials. Trials reported improvement using a range of related measures; standardized, pooled findings were translated onto a 6-point improvement scale.
  
  
  RESULTS
  The review included 177 randomized controlled trials with 34,808 participants, including 26 trials of scalp psoriasis and 6 trials of inverse and/or facial psoriasis. Typical trial duration was 3 to 8 weeks. When compared with placebo (emollient base), the average improvement for vitamin-D analogues and potent corticosteroids was approximately 1 point, dithranol 1.2 points, very potent corticosteroids 1.8 points, and combined vitamin-D analogue plus steroid 1.4 points once daily and 2.2 points twice daily. However, these are indicative benefits drawn from heterogeneous trial findings. Corticosteroids were more effective than vitamin D for treating psoriasis of the scalp. For both body and scalp psoriasis, potent corticosteroids were less likely than vitamin D to cause skin irritation.
  
  
  CONCLUSIONS
  Reporting of benefits, adverse effects, and safety assessment methods was often inadequate. In many comparisons, heterogeneity made the size of treatment benefit uncertain.
  
  
  CONCLUSIONS
  Corticosteroids are as effective as vitamin-D analogues and cause less skin irritation. However, further research is needed to inform long-term maintenance treatment and provide appropriate safety data.
authors.affiliation: Center for Health Economics, University of York, York, United Kingdom. Electronic address: anne.mason@york.ac.uk.
authors.forename: Anne
authors.initials: A
authors.lastname: Mason
authors.affiliation: School of Medicine, Pharmacy, and Health, Durham University, Stockton-on-Tees, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Mason
authors.affiliation: Academic Unit of Dermatology Research, University of Sheffield Medical School, Sheffield, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Cork
authors.affiliation: School of Medicine, Pharmacy, and Health, Durham University, Stockton-on-Tees, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Hancock
authors.affiliation: Metaxis Ltd, Curbridge, United Kingdom.
authors.forename: Gordon
authors.initials: G
authors.lastname: Dooley
mesh_terms: D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002908:Chronic Disease; D006801:Humans; D011565:Psoriasis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D014807:Vitamin D / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D014807:Vitamin D
keywords: BD; CI; IAGI; Investigator Assessment of Global Improvement; OD; SD; SMD; confidence interval; drug administration; drug safety; once daily; psoriasis; review; standard deviation; standardized mean difference; topical; treatment outcome; twice daily