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Topical Therapy I: Corticosteroids and Vitamin D Analogues

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Advances in Psoriasis

Abstract

Psoriasis is a life-long disease that affects approximately 2 % of the population. Approximately 80 % of psoriasis patients have mild to moderate disease. Topical therapies play an important role in the treatment of patients with mild to moderate disease. Patients often start treatment with topical steroids, vitamin D3 cream or ointment or a combination of the two. This chapter will describe the pharmacokinetics and mechanism of action of topical steroids and vitamin D analogues. Long-term side effects, the importance of vehicle, potency ratings as well as combination use with other treatment modalities will be discussed.

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References

  1. Cornell RC, Stoughton RB. Correlation of the vasoconstriction assay and clinical activity in psoriasis. Arch Dermatol. 1985;121:63–7.

    Article  CAS  PubMed  Google Scholar 

  2. Wolverton SE. Comprehensive dermatologic drug therapy. Philadelphia: Saunders Elsevier; 2007. p. 595–624.

    Google Scholar 

  3. Vickers CF. Existence of reservoir in the stratum corneum. Experimental proof. Arch Dermatol. 1963;88:20–3.

    Article  CAS  PubMed  Google Scholar 

  4. Stoughton RB, Wullich K. The same glucocorticoid in brand-name products. Does increasing the concentration result in greater topical biologic activity? Arch Dermatol. 1989;125:1509–11.

    Article  CAS  PubMed  Google Scholar 

  5. Ference JD, Last AR. Choosing topical corticosteroids. Am Fam Physician. 2009;79:135–40.

    PubMed  Google Scholar 

  6. MacGregor RR, Spagnuolo PJ, Lentnek AL. Inhibition of granulocyte adherence by ethanol, prednisone, and aspirin, measured with an assay system. N Engl J Med. 1974;291:642–6.

    Article  CAS  PubMed  Google Scholar 

  7. Dale DC, Fauci AS, Wolff SM. Alternate-day prednisone. Leukocyte kinetics and susceptibility to infections. N Engl J Med. 1974;291:1154–8.

    Article  CAS  PubMed  Google Scholar 

  8. Dale DC, Fauci AS, Guerry DI, Wolff SM. Comparison of agents producing a neutrophilic leukocytosis in man. Hydrocortisone, prednisone, endotoxin, and etiocholanolone. J Clin Invest. 1975;56:808–13.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Hattori T, Hirata F, Hoffman T, Hizuta A, Herberman RB. Inhibition of human natural killer (NK) activity and antibody dependent cellular cytotoxicity (ADCC) by lipomodulin, a phospholipase inhibitory protein. J Immunol. 1983;131:662–5.

    CAS  PubMed  Google Scholar 

  10. Hoffman T, Hirata F, Bougnoux P, Fraser BA, Goldfarb RH, Herberman RB, et al. Phospholipid methylation and phospholipase A2 activation in cytotoxicity by human natural killer cells. Proc Natl Acad Sci U S A. 1981;78:3839–43.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Fisher LB, Maibach HI. The effect of corticosteroids on human epidermal mitotic activity. Arch Dermatol. 1971;103:39–44.

    Article  CAS  PubMed  Google Scholar 

  12. Rokowski RJ, Sheehy J, Cutroneo KR. Glucocorticoid-mediated selective reduction of functioning collagen messenger ribonucleic acid. Arch Biochem Biophys. 1981;210:74–81.

    Article  CAS  PubMed  Google Scholar 

  13. Oikarinen J, Pihlajaniemi T, Hamalainen L, Kivirikko KI. Cortisol decreases the cellular concentration of translatable procollagen mRNA species in cultured human skin fibroblasts. Biochim Biophys Acta. 1983;741:297–302.

    Article  CAS  PubMed  Google Scholar 

  14. Oikarinen A, Hannuksela M. Effect of hydrocortisone-17-butyrate, hydrocortisone, and clobetasol-17-propionate on prolyl hydroxylase activity in human skin. Arch Dermatol Res. 1980;267:79–82.

    Article  CAS  PubMed  Google Scholar 

  15. Katz HI, Prawer SE, Medansky RS, Krueger GG, Mooney JJ, Jones ML, et al. Intermittent corticosteroid maintenance treatment of psoriasis: a double-blind multicenter trial of augmented betamethasone dipropionate ointment in a pulse dose treatment regimen. Dermatologica. 1991;183:269–74.

    Article  CAS  PubMed  Google Scholar 

  16. Katz HI, Hien NT, Prawer SE, Mastbaum LI, Mooney JJ, Samson CR. Superpotent topical steroid treatment of psoriasis vulgaris–clinical efficacy and adrenal function. J Am Acad Dermatol. 1987;16:804–11.

    Article  CAS  PubMed  Google Scholar 

  17. Katz HI, Hien NT, Prawer SE, Scott JC, Grivna EM. Betamethasone dipropionate in optimized vehicle. Intermittent pulse dosing for extended maintenance treatment of psoriasis. Arch Dermatol. 1987;123:1308–11.

    Article  CAS  PubMed  Google Scholar 

  18. Kragballe K, Larsen FG. A hydrocolloid occlusive dressing plus triamcinolone acetonide cream is superior to clobetasol cream in palmo-plantar pustulosis. Acta Derm Venereol. 1991;71:540–2.

    CAS  PubMed  Google Scholar 

  19. David M, Lowe NJ. Psoriasis therapy: comparative studies with a hydrocolloid dressing, plastic film occlusion, and triamcinolone acetonide cream. J Am Acad Dermatol. 1989;21:511–4.

    Article  CAS  PubMed  Google Scholar 

  20. Krueger GG, O’Reilly MA, Weidner M, Dromgoole SH, Killey FP. Comparative efficacy of once-daily flurandrenolide tape versus twice-daily diflorasone diacetate ointment in the treatment of psoriasis. J Am Acad Dermatol. 1998;38:186–90.

    Article  CAS  PubMed  Google Scholar 

  21. van der Vleuten CJ, van Vlijmen-Willems IM, de Jong EM, van de Kerkhof PC. Clobetasol-17 propionate lotion under hydrocolloid dressing (Duoderm ET) once weekly versus unoccluded clobetasol-17-propionate ointment twice daily in psoriasis: an immunohistochemical study on remission and relapse. Arch Dermatol Res. 1999;291:390–5.

    Article  PubMed  Google Scholar 

  22. Volden G, Kragballe K, Van De Kerkhof PC, Aberg K, White RJ. Remission and relapse of chronic plaque psoriasis treated once a week with clobetasol propionate occluded with a hydrocolloid dressing versus twice daily treatment with clobetasol propionate alone. J Dermatolog Treat. 2001;12:141–4.

    Article  CAS  PubMed  Google Scholar 

  23. Franz TJ, Parsell DA, Halualani RM, Hannigan JF, Kalbach JP, Harkonen WS. Betamethasone valerate foam 0.12 %: a novel vehicle with enhanced delivery and efficacy. Int J Dermatol. 1999;38:628–32.

    Article  CAS  PubMed  Google Scholar 

  24. Andreassi L, Giannetti A, Milani M. Efficacy of betamethasone valerate mousse in comparison with standard therapies on scalp psoriasis: an open, multicentre, randomized, controlled, cross-over study on 241 patients. Br J Dermatol. 2003;148:134–8.

    Article  CAS  PubMed  Google Scholar 

  25. van der Rhee HJ, Tijssen JG, Herrmann WA, Waterman AH, Polano MK. Combined treatment of psoriasis with a new aromatic retinoid (Tigason) in low dosage orally and triamcinolone acetonide cream topically: a double-blind trial. Br J Dermatol. 1980;102:203–12.

    Article  PubMed  Google Scholar 

  26. Cunliffe WJ, Burton JL, Holti G, Wright V. Hazards of steroid therapy in hepatic failure. Br J Dermatol. 1975;93:183–5.

    Article  CAS  PubMed  Google Scholar 

  27. West DP, Worobec S, Solomon LM. Pharmacology and toxicology of infant skin. J Invest Dermatol. 1981;76:147–50.

    Article  CAS  PubMed  Google Scholar 

  28. Drake LA, Dinehart SM, Farmer ER, Goltz RW, Graham GF, Hordinsky MK, et al. Guidelines of care for the use of topical glucocorticosteroids. American Academy of Dermatology. J Am Acad Dermatol. 1996;35:615–9.

    Article  CAS  PubMed  Google Scholar 

  29. May P, Stein EJ, Ryter RJ, Hirsh FS, Michel B, Levy RP. Cushing syndrome from percutaneous absorption of triamcinolone cream. Arch Intern Med. 1976;136:612–3.

    Article  CAS  PubMed  Google Scholar 

  30. Himathongkam T, Dasanabhairochana P, Pitchayayothin N, Sriphrapradang A. Florid Cushing’s syndrome and hirsutism induced by desoximetasone. JAMA. 1978;239:430–1.

    Article  CAS  PubMed  Google Scholar 

  31. Carruthers JA, August PJ, Staughton RC. Observations on the systemic effect of topical clobetasol propionate (Dermovate). Br Med J. 1975;4:203–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Kirby JD, Munro DD. Steroid-induced atrophy in an animal and human model. Br J Dermatol. 1976;94 Suppl 12:111–9.

    Article  PubMed  Google Scholar 

  33. Hong E, Smith S, Fischer G. Evaluation of the atrophogenic potential of topical corticosteroids in pediatric dermatology patients. Pediatr Dermatol. 2011;28:393–6.

    Article  CAS  PubMed  Google Scholar 

  34. Aggarwal RK, Potamitis T, Chong NH, Guarro M, Shah P, Kheterpal S. Extensive visual loss with topical facial steroids. Eye (Lond). 1993;7(Pt 5):664–6.

    Article  Google Scholar 

  35. thoe Schwartzenberg GW, Buys YM. Glaucoma secondary to topical use of steroid cream. Can J Ophthalmol. 1999;34:222–5.

    Google Scholar 

  36. Guin JD. Contact sensitivity to topical corticosteroids. J Am Acad Dermatol. 1984;10:773–82.

    Article  CAS  PubMed  Google Scholar 

  37. Tegner E. Contact allergy to corticosteroids. Int J Dermatol. 1976;15:520–3.

    Article  CAS  PubMed  Google Scholar 

  38. Lauerma AI, Maibach HI, Granlund H, Erkko P, Kartamaa M, Stubb S. Inhibition of contact allergy reactions by topical FK506. Lancet. 1992;340:556.

    Article  CAS  PubMed  Google Scholar 

  39. Lebwohl M, Ting PT, Koo JY. Psoriasis treatment: traditional therapy. Ann Rheum Dis. 2005;64 Suppl 2:ii83–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  40. Miller JJ, Roling D, Margolis D, Guzzo C. Failure to demonstrate therapeutic tachyphylaxis to topically applied steroids in patients with psoriasis. J Am Acad Dermatol. 1999;41:546–9.

    CAS  PubMed  Google Scholar 

  41. Morimoto S, Kumahara Y. A patient with psoriasis cured by 1 alpha-hydroxyvitamin D3. Med J Osaka Univ. 1985;35:51–4.

    CAS  PubMed  Google Scholar 

  42. Kragballe K, Wildfang IL. Calcipotriol (MC 903), a novel vitamin D3 analogue stimulates terminal differentiation and inhibits proliferation of cultured human keratinocytes. Arch Dermatol Res. 1990;282:164–7.

    Article  CAS  PubMed  Google Scholar 

  43. Kragballe K. The future of vitamin D in dermatology. J Am Acad Dermatol. 1997;37:S72–6.

    CAS  PubMed  Google Scholar 

  44. Bikle DD, Ng D, Tu CL, Oda Y, Xie Z. Calcium- and vitamin D-regulated keratinocyte differentiation. Mol Cell Endocrinol. 2001;177:161–71.

    Article  CAS  PubMed  Google Scholar 

  45. Kang S, Yi S, Griffiths CE, Fancher L, Hamilton TA, Choi JH. Calcipotriene-induced improvement in psoriasis is associated with reduced interleukin-8 and increased interleukin-10 levels within lesions. Br J Dermatol. 1998;138:77–83.

    Article  CAS  PubMed  Google Scholar 

  46. van de Kerkhof PC. An update on vitamin D3 analogues in the treatment of psoriasis. Skin Pharmacol Appl Skin Physiol. 1998;11:2–10.

    Article  PubMed  Google Scholar 

  47. Barker JN, Ashton RE, Marks R, Harris RI, Berth-Jones J. Topical maxacalcitol for the treatment of psoriasis vulgaris: a placebo-controlled, double-blind, dose-finding study with active comparator. Br J Dermatol. 1999;141:274–8.

    Article  CAS  PubMed  Google Scholar 

  48. Vakirlis E, Kastanis A, Ioannides D. Calcipotriol/betamethasone dipropionate in the treatment of psoriasis vulgaris. Ther Clin Risk Manag. 2008;4:141–8.

    CAS  PubMed Central  PubMed  Google Scholar 

  49. Kragballe K, Gjertsen BT, De Hoop D, Karlsmark T, van de Kerkhof PC, Larko O, et al. Double-blind, right/left comparison of calcipotriol and betamethasone valerate in treatment of psoriasis vulgaris. Lancet. 1991;337:193–6.

    Article  CAS  PubMed  Google Scholar 

  50. Cunliffe WJ, Berth-Jones J, Claudy A, Fairiss G, Goldin D, Gratton D, et al. Comparative study of calcipotriol (MC 903) ointment and betamethasone 17-valerate ointment in patients with psoriasis vulgaris. J Am Acad Dermatol. 1992;26:736–43.

    Article  CAS  PubMed  Google Scholar 

  51. Pariser DM, Pariser RJ, Breneman D, Lebwohl M, Kalb R, Moore J, et al. Calcipotriene ointment applied once a day for psoriasis: a double-blind, multicenter, placebo-controlled study. Arch Dermatol. 1996;132:1527.

    Article  CAS  PubMed  Google Scholar 

  52. Ashcroft DM, Po AL, Williams HC, Griffiths CE. Systematic review of comparative efficacy and tolerability of calcipotriol in treating chronic plaque psoriasis. BMJ. 2000;320:963–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  53. Kragballe K, Barnes L, Hamberg KJ, Hutchinson P, Murphy F, Moller S, et al. Calcipotriol cream with or without concurrent topical corticosteroid in psoriasis: tolerability and efficacy. Br J Dermatol. 1998;139:649–54.

    Article  CAS  PubMed  Google Scholar 

  54. Bruce S, Epinette WW, Funicella T, Ison A, Jones EL, Loss Jr R, et al. Comparative study of calcipotriene (MC 903) ointment and fluocinonide ointment in the treatment of psoriasis. J Am Acad Dermatol. 1994;31:755–9.

    Article  CAS  PubMed  Google Scholar 

  55. Camarasa JM, Ortonne JP, Dubertret L. Calcitriol shows greater persistence of treatment effect than betamethasone dipropionate in topical psoriasis therapy. J Dermatolog Treat. 2003;14:8–13.

    Article  CAS  PubMed  Google Scholar 

  56. Ramsay CA, Berth-Jones J, Brundin G, Cunliffe WJ, Dubertret L, van de Kerkhof PC, et al. Long-term use of topical calcipotriol in chronic plaque psoriasis. Dermatology. 1994;189:260–4.

    Article  CAS  PubMed  Google Scholar 

  57. Park SB, Suh DH, Youn JI. A pilot study to assess the safety and efficacy of topical calcipotriol treatment in childhood psoriasis. Pediatr Dermatol. 1999;16:321–5.

    Article  CAS  PubMed  Google Scholar 

  58. Lebwohl M, Siskin SB, Epinette W, Breneman D, Funicella T, Kalb R, et al. A multicenter trial of calcipotriene ointment and halobetasol ointment compared with either agent alone for the treatment of psoriasis. J Am Acad Dermatol. 1996;35:268–9.

    Article  CAS  PubMed  Google Scholar 

  59. Lebwohl M. Topical application of calcipotriene and corticosteroids: combination regimens. J Am Acad Dermatol. 1997;37:S55–8.

    Article  CAS  PubMed  Google Scholar 

  60. Papp KA, Guenther L, Boyden B, Larsen FG, Harvima RJ, Guilhou JJ, et al. Early onset of action and efficacy of a combination of calcipotriene and betamethasone dipropionate in the treatment of psoriasis. J Am Acad Dermatol. 2003;48:48–54.

    Article  PubMed  Google Scholar 

  61. Guenther LC. Treatments for scalp psoriasis with emphasis on calcipotriol plus betamethasone dipropionate gel (Xamiol). Skin Therapy Lett. 2009;14:1–4.

    CAS  PubMed  Google Scholar 

  62. Kragballe K. Combination of topical calcipotriol (MC 903) and UVB radiation for psoriasis vulgaris. Dermatologica. 1990;181:211–4.

    Article  CAS  PubMed  Google Scholar 

  63. Hecker D, Lebwohl M. Topical calcipotriene in combination with UVB phototherapy for psoriasis. Int J Dermatol. 1997;36:302–3.

    Article  CAS  PubMed  Google Scholar 

  64. Speight EL, Farr PM. Calcipotriol improves the response of psoriasis to PUVA. Br J Dermatol. 1994;130:79–82.

    Article  CAS  PubMed  Google Scholar 

  65. Lebwohl M, Quijije J, Gilliard J, Rollin T, Watts O. Topical calcitriol is degraded by ultraviolet light. J Invest Dermatol. 2003;121:594–5.

    Article  CAS  PubMed  Google Scholar 

  66. van de Kerkhof PC, Cambazard F, Hutchinson PE, Haneke E, Wong E, Souteyrand P, et al. The effect of addition of calcipotriol ointment (50 micrograms/g) to acitretin therapy in psoriasis. Br J Dermatol. 1998;138:84–9.

    Article  PubMed  Google Scholar 

  67. Grossman RM, Thivolet J, Claudy A, Souteyrand P, Guilhou JJ, Thomas P, et al. A novel therapeutic approach to psoriasis with combination calcipotriol ointment and very low-dose cyclosporine: results of a multicenter placebo-controlled study. J Am Acad Dermatol. 1994;31:68–74.

    Article  CAS  PubMed  Google Scholar 

  68. Kokelj F, Torsello P, Plozzer C. Calcipotriol improves the efficacy of cyclosporine in the treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol. 1998;10:143–6.

    Article  CAS  PubMed  Google Scholar 

  69. de Jong EM, Mork NJ, Seijger MM, De La Brassine M, Lauharanta J, Jansen CT, et al. The combination of calcipotriol and methotrexate compared with methotrexate and vehicle in psoriasis: results of a multicentre placebo-controlled randomized trial. Br J Dermatol. 2003;148:318–25.

    Article  PubMed  Google Scholar 

  70. Kircik LH. Topical calcipotriene 0.005 % and betamethasone dipropionate 0.064 % maintains efficacy of etanercept after step-down dose in patients with moderate-to-severe plaque psoriasis: results of an open label trial. J Drugs Dermatol. 2011;10:878–82.

    PubMed  Google Scholar 

  71. Campione E, Mazzotta A, Paterno EJ, Diluvio L, Prinz JC, Chimenti S. Effect of calcipotriol on etanercept partial responder psoriasis vulgaris and psoriatic arthritis patients. Acta Derm Venereol. 2009;89:288–91.

    Article  CAS  PubMed  Google Scholar 

  72. Lebwohl M, Ali S. Treatment of psoriasis. Part 1. Topical therapy and phototherapy. J Am Acad Dermatol. 2001;45:487–98.

    Article  CAS  PubMed  Google Scholar 

  73. Fogh K, Kragballe K. Vitamin D3 analogues. Clin Dermatol. 1997;15:705–13.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Fletcher Allen Health Care, University of Vermont College of Medicine, Burlington, Vermont, USA

    Ani L. Tajirian MD

  2. Department of Dermatology, Mount Sinai Medical Center, New York, NY, 10029, USA

    Leon Kircik MD

Authors
  1. Ani L. Tajirian MD
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  2. Leon Kircik MD
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Correspondence to Leon Kircik MD .

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Editors and Affiliations

  1. St. Luke's -Roosevelt Hospital Center, New York, New York, USA

    Jeffrey M. Weinberg

  2. Department of Dermatology, Icahn School of Medicine, New York, New York, USA

    Mark Lebwohl

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Tajirian, A.L., Kircik, L. (2014). Topical Therapy I: Corticosteroids and Vitamin D Analogues. In: Weinberg, J., Lebwohl, M. (eds) Advances in Psoriasis. Springer, London. https://doi.org/10.1007/978-1-4471-4432-8_6

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  • DOI: https://doi.org/10.1007/978-1-4471-4432-8_6

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