Combination treatment seems rarely to be used in psoriasis
Ashcroft et al report a systematic review of the comparative
efficacy and tolerability of calcipotriol, a synthetic vitamin
D3 analogue, in chronic plaque psoriasis.1 We
have recently completed a general practice based audit of the
treatments offered to patients with mild to moderate chronic plaque psoriasis.
We found that only three of 14 patients who had been prescribed a
corticosteroid were using a vitamin D3 analogue as part of
combination treatment. The remainder had not received a vitamin D3 analogue at any time. Despite the risks of using topical
steroids, corticosteroids still remain the preferred treatment for
psoriasis, and on average 55% of patients receive potent topical
steroids.2 Combination treatment with vitamin
D3 analogues and corticosteroids has been recommended for
mild to moderate plaque psoriasis in numerous trials.3-5
Although our study is limited by its small sample size, and we cannot
conclude that these results reflect general trends, we suggest that the
reasons why this combination treatment has not been implemented should
be investigated: is it a cost issue? Patients should be reviewed so
that a decision can be made on which ones should be offered combination
treatment. Perhaps topical corticosteroids should be considered only in
those with a poor therapeutic response to calcipotriol.4
If a corticosteroid is used for chronic plaque psoriasis, consideration
should be given to prescribing it together with a vitamin
D3 analogue, since combination treatment is more
efficacious than corticosteroids alone.3 We postulate from
our small audit that although this treatment protocol is recommended,
doctors are unaware of it; this needs to be addressed to provide
optimal care.
Damien Cullington, third year medical student.
Daye{at}cullington0.demon.co.uk
Anita Jhamatt, third year medical student.
Liverpool Medical School, Liverpool L69 3BX
1.
|
Ashcroft MA, Li Wan Po A, Williams HC, Griffiths CEM.
Systematic review of the comparative efficacy and tolerability of calcipotriol in treating chronic plaque psoriasis.
BMJ 2000; 320:963-967 (8 April.)
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2.
|
Kownaki S. Team care in psoriasis
Update 1999;Jan(suppl 1):3-5
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3.
| 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;139:649-654
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4.
|
Ruzicka T, Lorenz B. Comparison of calcipotriol monotherapy and a combination of calcipotriol and betamethasone valerate after 2 weeks treatment with calcipotriol in the topical therapy of psoriasis vulgaris: a multicentre, double-blind, randomised study.
Br J Dermatol 1998;138:254-258
|
5.
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Lebwohl M, Siskin SB, Epinette W. A multi-centre trial of calcipotriol ointment and halobetasol ointment with either agent alone for the treatment of psoriasis.
J Am Acad Dermatol 1996;35:268-269
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