Clinical Health Updates

Betamethasone, calcipotriol best for intertriginous psoriasis

Clinical Question:
What is the best treatment for psoriasis?

Bottom Line:
The 1% pimecrolimus was shown to be less potent than 0.1% betamethasone in the treatment of IP. Considering the adverse-effect profile of long-term application of corticosteroids, occasional or intermittent rescue therapy with short-term topical corticosteroids and maintenance with a less potent agent, such as 1% pimecrolimus or 0.005% calcipotriol, might be appropriate for patients with IP in general practice.

Reference:
Kreuter A, Sommer A, Hyun J, et al. 1% pimecrolimus, 0.005% calcipotriol, and 0.1% betamethasone in the treatment of intertriginous psoriasis. A double-blind, randomized controlled study. Arch Dermatol 2006;142:1138-1143.

Study Design:
Randomized controlled trial (double-blinded)

Synopsis:
IP occurs in the axillae, under the breasts, in the inguinal folds, and on the buttocks and genitals. It is very pruritic and is typically worsened by perspiration. Treatment options (all topical) include corticosteroids, pimecrolimus and tacrolimus, and calcipotriol. In this study, 80 patients with IP from a dermatology clinic were randomly assigned to receive either 1% pimecrolimus, 0.005% calcipotriol, 0.1% betamethasone valerate, or vehicle cream once daily for 4 weeks, followed by 6 weeks without treatment. The primary outcome was the Modified Psoriasis Area and Severity Index (M-PASI) measured at days 0, 14, 28, 42, and 70. Groups were balanced at the start of the study and analysis was by intention to treat. There were only 5 withdrawals, including 3 in the betamethasone group. The mean M-PASI scores decreased from 22.1 to 2.9 in the betamethasone group (86%), from 25.3 to 9.7 in the calcipotriol group (62%), from 19.5 to 11.5 in the pimecrolimus group (39.7%), and from 18.2 to 13.8 in the placebo group (21.1%). There were statistically significant differences between betamethasone and pimecrolimus and vehicle cream, and between calcipotriol and vehicle cream. There was no significant difference between pimecrolimus and vehicle cream. The authors of this study, funded by the manufacturer of pimecrolimus, play up the adverse effects of betamethasone and calcipotriol while ignoring the fact that adverse effects were actually most common in the pimecrolimus group. It is important to note that the European Medicines Agency, which checks the safety of drugs in the European Union, has warned doctors and patients using pimecrolimus about a possible risk of skin cancer and lymphoma.