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J Am Acad Dermatol. 2013 Nov;69(5):799-807. doi: 10.1016/j.jaad.2013.06.027.

Topical treatments for chronic plaque psoriasis: an abridged Cochrane systematic review.

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  • 1Center for Health Economics, University of York, York, United Kingdom. Electronic address: anne.mason@york.ac.uk.

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.

LIMITATIONS:

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.

Copyright © 2013 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

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

[PubMed - indexed for MEDLINE]
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