title: Topical long-term therapy of psoriasis with vitamin D₃ analogues, corticosteroids and their two compound formulations: position paper on evidence and use in daily practice.
abstract: BACKGROUND
  Current data from daily practice show that vitamin D₃ analogues, corticosteroids and their fixed combination products are used heterogeneously for topical long-term treatment of psoriasis.
  
  
  OBJECTIVE
  To evaluate scientific evidence about topical long-term therapy with vitamin D3 analogues, corticosteroids and their two-compound-products in psoriasis vulgaris and scalp psoriasis and to develop daily practice recommendations.
  
  
  METHODS
  Systematic literature review via PubMed and Embase and informal expert consensus.
  
  
  RESULTS
  The search strategy identified 21 relevant clinical trials. Best evidence regarding topical long term treatment was available for the two-compound-formulation containing calcipotriene and betamethasone. In a comparative trial in psoriasis vulgaris the two-compound-formulation showed superior tolerability and cost effectiveness compared to monotherapy. In scalp psoriasis the two-compound-gel was superior compared to calcipotriene monotherapy. Standardized and simplified treatment application modes resulted in a better clinical outcome comparing to on-demand therapies.
  Patients should be proactively involved in the choice of treatment, formulation and mode of application. Besides long-term treatment with the two-compound-formulation other treatment regimens including calcipotriene monotherapy can also be considered. Due to a favorable risk-benefit ratio in maintenance trials and due to better cost-effectiveness the application of two-compound-products once or twice a week after initial therapy is recommended.
authors.affiliation: CVderm - Centre of Excellence for Health Services Research in Dermatology; Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Augustin
authors.forename: Ulrich
authors.initials: U
authors.lastname: Mrowietz
authors.forename: Bernd
authors.initials: B
authors.lastname: Bonnekoh
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosenbach
authors.forename: Diamant
authors.initials: D
authors.lastname: Thaçi
authors.forename: Michael
authors.initials: M
authors.lastname: Reusch
authors.forename: Michael
authors.initials: M
authors.lastname: Ardabili
authors.forename: Kristian
authors.initials: K
authors.lastname: Reich
mesh_terms: D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D001623:Betamethasone / Q000008:administration & dosage; D002117:Calcitriol / Q000031:analogs & derivatives; D002762:Cholecalciferol / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D002986:Clinical Trials as Topic; D004338:Drug Combinations; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D008134:Long-Term Care; D011565:Psoriasis / Q000188:drug therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D004338:Drug Combinations; C055085:calcipotriene; D002762:Cholecalciferol; D001623:Betamethasone; D002117:Calcitriol