title: An investigator-initiated, double-blind, vehicle-controlled pilot study: assessment for tachyphylaxis to topically occluded halobetasol 0.05% ointment in the treatment of psoriasis.
abstract: BACKGROUND
  Topical corticosteroids are the most common first-line treatment for psoriasis. Tachyphylaxis, a decreased response to treatment with repetitive application of the drug, is a controversial phenomenon associated with topical corticosteroid treatment.
  
  
  OBJECTIVE
  We sought to prove or disprove tachyphylaxis to occluded halobetasol 0.05% versus vehicle.
  
  
  METHODS
  Patients with plaque psoriasis were recruited to this study. The study involved 3 phases (1, 2A, and 2B) with each phase being separated by a treatment vacation period. In phases 1 and 2A, 2 plaques were randomized to either halobetasol 0.05% or vehicle ointment application. In phase 2B, halobetasol 0.05% was applied to both. Target Lesion Severity Scale was used for clinical assessment.
  
  
  RESULTS
  Twenty patients were enrolled. No difference in time to clearance (P=.88) or time to recurrence (P=.92) of the treated plaques was found between phases 1 and 2A. Percentage of improvement was higher in phase 2A compared with phase 1 (89.4%, P<.05 vs 71%, P<.05), as a result of reduction of vehicle effect. In phase 2B, a greater improvement was found for previously corticosteroid-treated plaques.
  
  
  CONCLUSIONS
  Limitations are small sample size and 1 corticosteroid tested.
  
  
  CONCLUSIONS
  No evidence of tachyphylaxis to the topical corticosteroid halobetasol 0.05% ointment treatment in patients with plaque psoriasis was found.
authors.affiliation: Laboratory for Investigative Dermatology, Rockefeller University, New York, New York. Electronic address: tczarnowic01@rockefeller.edu.
authors.forename: Tali
authors.initials: T
authors.lastname: Czarnowicki
authors.affiliation: Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Rita V
authors.initials: RV
authors.lastname: Linkner
authors.affiliation: Center for Clinical and Translational Science, Rockefeller University, New York, New York.
authors.forename: Mayte
authors.initials: M
authors.lastname: Suárez-Fariñas
authors.affiliation: Department of Dermatology, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Arie
authors.initials: A
authors.lastname: Ingber
authors.affiliation: Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Mark
authors.initials: M
authors.lastname: Lebwohl
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D002990:Clobetasol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003879:Dermatologic Agents / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009824:Ointments / Q000008:administration & dosage; D010865:Pilot Projects; D011565:Psoriasis / Q000188:drug therapy*; D012720:Severity of Illness Index; D013618:Tachyphylaxis; D055815:Young Adult
chemical_list: D003879:Dermatologic Agents; D009824:Ointments; C064466:halobetasol; D002990:Clobetasol
keywords: compliance; corticosteroid; halobetasol 0.05%; psoriasis; tachyphylaxis; vehicle