Topical treatments for scalp psoriasis: summary of a Cochrane Systematic Review.
People with chronic plaque psoriasis often have lesions on the scalp that are difficult to treat. This report is a summary of a Cochrane review on the efficacy and safety of topical treatments for scalp psoriasis. For quality-of-evidence assessment, we used the Grading of Recommendations Assessment, Development and Evaluation Working Group approach. Only randomized controlled trials (RCTs) were eligible for inclusion. We searched the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase and LILACS; ongoing trials; indexes of included studies and screened abstracts of six psoriasis-specific conferences up to August 2015. We included 59 RCTs, with 11 561 participants overall. Most findings were limited to short-term treatments (< 6 months). According to the clinician and patients' self-assessment, a corticosteroid-vitamin D combination (e.g. betamethasone dipropionate plus calcipotriol) and corticosteroids of high and very high potency were better than vitamin D. The two-compound combination was superior to the corticosteroid alone, but the additional benefit was small. Reporting of quality-of-life data was insufficient. The two-compound combination and corticosteroids caused fewer withdrawals due to adverse events than vitamin D. There was no difference between the two-compound combination and corticosteroid monotherapy concerning this outcome. Overall the evidence was of moderate quality. Evaluation of other topical treatments was limited. Given the comparable safety profile and only slim benefit of the two-compound combination over the corticosteroid alone, monotherapy with generic topical corticosteroids of high and very high potency may be fully acceptable for short-term therapy. More quality-of-life data and long-term assessments are needed.
Division of Evidence Based Medicine (dEBM), Department of Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Schlager
Division of Evidence Based Medicine (dEBM), Department of Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Rosumeck
Division of Evidence Based Medicine (dEBM), Department of Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Werner
Department of Medical Consulting, Federal Joint Committee (G-BA, Gemeinsamer Bundesausschuss), Wegelystr. 8, 10623, Berlin, Germany.
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Jacobs
Zentrum für evidenzbasierte Gesundheitsversorgung (ZEGV), Medical Faculty Carl Gustav Carus, Technischen Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
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Schmitt
Division of Evidence Based Medicine (dEBM), Department of Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Schlager
Division of Evidence Based Medicine (dEBM), Department of Dermatology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Nast
D000279:Administration, Cutaneous; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D003879:Dermatologic Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012536:Scalp Dermatoses / Q000188:drug therapy*; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage
D000305:Adrenal Cortex Hormones; D003879:Dermatologic Agents; D014807:Vitamin D