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Background: Psoriasis has important physical and psychosocial effects that extend beyond the skin. Understanding the impact of treatment on health‐related quality of life (HRQoL) and patient‐perceived symptom severity in psoriasis is key to clinical decision‐making. Objectives: This post hoc analysis of the PSO‐LONG trial data assessed the impact of long‐term proactive or reactive management with fixed‐dose combination calcipotriene 50 µg/g and betamethasone dipropionate 0.5 mg/g (Cal/BD) foam on patient‐reported outcomes (PROs) in patients with psoriasis vulgaris. Methods: Five hundred and twenty‐one patients from the Phase 3, randomized, double‐blind PSO‐LONG trial were included. An initial 4‐week, open‐label phase of fixed‐dose combination Cal/BD foam once daily (QD) was followed by a 52‐week maintenance phase, at the start of which patients were randomized to a proactive management arm (Cal/BD foam twice weekly) or reactive management arm (vehicle foam twice weekly). Patient‐perceived symptom severity and HRQoL were assessed using the Psoriasis Symptom Inventory (PSI), the Dermatology Life Quality Index (DLQI) and the EuroQol‐5D for psoriasis (EQ‐5D‐5L‐PSO). Results: Statistically and clinically significant improvements were observed across all PRO measures. The mean difference (standard deviation) from baseline to Week 4 was −8.97 (6.18) for PSI, −6.02 (5.46) for DLQI and 0.11 (0.15) for EQ‐5D‐5L‐PSO scores. During maintenance, patients receiving reactive management had significantly higher DLQI (15% [p = 0.007]) and PSI (15% [p = 0.0128]) and a numerically lower EQ‐5D‐5L‐PSO mean area under the curve score than patients receiving proactive management (1% [p = 0.0842]). Conclusions: Cal/BD foam significantly improved DLQI, EQ‐5D‐5L‐PSO and PSI scores during the open‐label and maintenance phases. Patients assigned to proactive management had significantly better DLQI and PSI scores and numerically better EQ‐5D‐5L‐PSO versus reactive management. Additionally, baseline flare was associated with worse PROs than the start of a relapse, and patients starting a relapse also had worse PROs than patients in remission. [ABSTRACT FROM AUTHOR]

A two-compound scalp formulation containing calcipotriol (50 μg/g) and betamethasone (0.5 mg/g; as dipropionate) (Xamiol, Taclonex Scalp) has been shown to be an effective and safe treatment for scalp psoriasis. The aim of this study was to investigate the clinical efficacy of the two-compound scalp formulation after 1 week of treatment. Pooled data from two large pivotal phase III trials with 2920 patients receiving once-daily treatment for up to 8 weeks with either the two-compound scalp formulation ( n = 1108), betamethasone dipropionate ( n = 1118), calcipotriol ( n = 558), or the vehicle ( n = 136) were analysed. The percentage of patients who had 'absent' or 'very mild' disease according to Investigator's Global Assessment after 1 week of treatment was significantly higher with the two-compound scalp formulation (30.6%) compared to betamethasone (24.1%; P < 0.001), calcipotriol (10.0%; P < 0.001) or vehicle (6.9%; P < 0.001). This data indicates that the two-compound scalp formulation demonstrated significant efficacy already after 1 week, with a faster onset of effect than either of the individual components in the same vehicle, in the treatment of scalp psoriasis. [ABSTRACT FROM AUTHOR]

Background Calcitriol and calcipotriol, two vitamin D derivatives, are available for topical treatment of psoriasis and have been shown to be effective. Aim To compare the efficacy and safety of calcitriol 3 µg/g and calcipotriol 50 µg/g. Methods This was a multicentre, randomized, investigator-masked, and parallel comparison in subjects with mild to moderate chronic plaque-type psoriasis receiving either calcitriol or calcipotriol ointment twice daily for 12 weeks. Efficacy evaluations comprised global improvement (on a 4-point scale from 0: no change or worse, to 3: clear or almost clear) assessed by the investigator and by the subject. Efficacy further included the ‘dermatological sum score’ at each study visit. Safety evaluations included adverse event reporting, cutaneous safety assessed by the investigator and cutaneous discomfort assessment by the subject (both on a 5-point scale from 0: none, to 4: very severe). Results A total of 250 subjects of both gender were recruited. At week 12, the LSmean score of global improvement rated by the investigator was 2.27 for calcitriol and 2.22 for calcipotriol. This difference was not statistically significant, with calcitriol demonstrating to be non-inferior to calcipotriol for global improvement. This same parameter was scored by the subject, with a mean of 2.12 for calcitriol and 2.09 for calcipotriol. The percentage of patients with at least marked improvement tended to be in favour of calcitriol (95.7% vs. 85% for calcipotriol). However, differences were not statistically significant. The mean worst score for the cutaneous safety assessment was higher in the calcipotriol group (0.3 vs. 0.1 and 0.4 vs. 0.2, by the investigator and the patient, respectively). These differences were statistically significant in favour of a better safety profile for calcitriol ( P = 0.0035). Fourteen dermatological and treatment-related adverse events were reported with calcipotriol vs. only five with calcitriol for a total of 22 adverse events reported throughout the study. Conclusion Calcitriol administered twice daily over a 12-week treatment period demonstrated similar efficacy to calcipotriol, while showing a significantly better safety profile. [ABSTRACT FROM AUTHOR]

Background Treatment of vitiligo is a challenge. Steroids are known to be effective but are associated with serious adverse effects. Many uncontrolled studies have shown calcipotriol to be a promising therapeutic modality in vitiligo. Objective To conduct a randomized trial to evaluate the effect of topical calcipotriol ointment (0.005%) and betamethasone dipropionate (0.05%) cream, given alone or in combination, in treatment of localized vitiligo. Methods Forty-nine patients with vitiligo affecting 5% of their skin were recruited. Patients were randomized into three groups. Group I patients were treated with betamethasone dipropionate (0.05%) cream twice daily. Group II patients were treated with calcipotriol ointment (0.005%) twice daily, and group III with betamethasone dipropionate (0.05%) in the morning and calcipotriol (0.005%) in the evening. Results Forty-five patients completed the study period of 3 months with 15 patients in each group. No patient achieved excellent (> 75%) pigmentation. Marked (50% to 75%) repigmentation was observed in 2 (13.3%), 1 (6.7%) and 4 (26.7%) patients in groups I, II and III, respectively. Moderate (25–50%) repigmentation was observed in 7 (46.7%), 5 (33.3%) and 7 (46.7%) patients in groups I, II and III, respectively. Patients with < 25% pigmentation were termed as minimal pigmentation or no response. The mean time for initial pigmentation to appear was 9.04 ± 2.0 weeks in group I, 10.18 ± 1.6 weeks in group II and 5.17 ± 2.4 weeks in group III ( P < 0.01). The acquired pigmentation in the lesions was more stable in group III as compared with patients in groups II and I ( P < 0.01). Side-effects in the form of atrophy and lesional burning sensations were more common in group I when compared with groups II and III ( P < 0.05). Conclusion Combined therapy appeared to give a significantly faster onset of repigmentation along with better stability of the achieved pigmentation and with lesser number of side-effects. [ABSTRACT FROM AUTHOR]

Background and objectives The effect of the established antipsoriatic treatment with topical calcipotriol (with a maximum of 100 g per week) in addition to systemic treatment with alefacept, a new biological agent for psoriasis, on epidermal cell populations in the psoriatic lesion was investigated using a combination of the Zenon labelling technique and microscopic image analysis. Epidermal cell populations were measured quantitatively with this sensitive method. Patients/methods Frozen sections of non-treated psoriatic epidermis and psoriatic epidermis treated with either alefacept intramuscular or alefacept intramuscular in combination with topical calcipotriol for 12 weeks were compared immunohistochemically. Antibodies against keratin 6, 10 and 15 were labelled with the Zenon technique, whereas antibodies against the Ki-67 antigen and beta-1 integrin were covalently Fluorescein Isothiocyanate (FITC)-labelled. Using image analysis, these markers were measured in the epidermis in a standardized manner. Results and conclusions Treatment of psoriasis with alefacept resulted in a good clinical response in several patients and in a normalization of epidermal expression of the immunohistochemical parameters for differentiation and proliferation. The addition of topical calcipotriol resulted in a faster clinical improvement with a similar overall clinical response and a similar response of epidermal cell populations as compared to treatment with alefacept monotherapy after 12 weeks of treatment. This study also suggests that the appearance of keratin 15 has a predictive value for the duration of remission. It can be concluded that the addition of a low-dose calcipotriol treatment does not contribute to the clinical efficacy of alefacept, both at the clinical level and with respect to markers for epidermal proliferation and differentiation. [ABSTRACT FROM AUTHOR]

Background Calcipotriol and betamethasone dipropionate are both proven products in the topical treatment of psoriasis. The efficacy and tolerability of a new ointment containing these two compounds has been assessed in six phase III clinical studies. Objective To compare the results obtained in the clinical studies of the new calcipotriol/betamethasone dipropionate ointment. Methods A total of 6050 patients with psoriasis took part in the six randomized, double-blind studies. The two-compound product was compared with each of the active constituents, either in the new ointment vehicle or in the marketed formulation. Results After 4 weeks of treatment the mean reduction in the Psoriasis Area and Severity Index (PASI) ranged from 65 to 74% with the two-compound product applied once or twice daily, from 46 to 59% with calcipotriol alone and from 57 to 63% with betamethasone dipropionate alone. The tolerability profile of the two-compound product was similar to betamethasone dipropionate monotherapy and better than calcipotriol alone. Conclusion The new two-compound product containing calcipotriol and betamethasone dipropionate was found to consistently provide rapid, highly effective treatment of psoriasis vulgaris. [ABSTRACT FROM AUTHOR]

Background Ointments, classically used for the treatment of dermatological diseases, are monophasic viscous semisolid formulations. According to the proportion of their compounds, they have physicochemical and organoleptic properties and when applied on skin show a specific behaviour allowing to be spread more or less easily. Objective To measure in vitro rheological characteristics of three vitamin D derivative ointments prescribed for the treatment of psoriasis, and to compare their viscosity and clinical acceptability when applied on the diseased skin. Methods Rheological characteristics of tacalcitol 4 µg/g, calcipotriol 50 µg/g and calcitriol 3 µg/g ointments were assessed by measuring the oscillatory viscoelastic parameters and the permanent flow analysis. Clinical acceptability was studied in 20 psoriatic male or female subjects, aged 18 years or older. A survey evaluated the acceptability of calcitriol vs. tacalcitol and calcipotriol. Questions included information about fluidity, spreading capacity and stickiness after application. Results We demonstrated that viscoelastic parameters were four times higher for ointment tacalcitol than for calcipotriol and calcitriol, corresponding to a higher consistency of ointment tacalcitol compared to calcipotriol and calcitriol showing both similar results; better fluidity was demonstrated by calcitriol than by tacalcitol and calcipotriol. Comparable results were obtained for the quality to be spread. The sensation of stickiness, significantly different between tacalcitol and calcitriol, was not different between calcipotriol and calcitriol. Conclusion The above results confirm the relationship between rheological in vitro and sensorial in vivo results: variations between different formulations may have an important influence on non-adherence and treatment failure. [ABSTRACT FROM AUTHOR]

Circumscribed palmar hypokeratosis is a recently described condition that consists of a solitary area of depressed skin affecting the palm (or sole). Its histopathological features include a thinned horny layer, a slightly diminished granular cell layer, and intraepidermal vacuolated cells. Prolonged treatment with topical calcipotriol resulted in complete recovery of the affected zone in the case reported here. A second biopsy of the lesion taken at around the fourth year of therapy showed a normalization of the granular layer, a reduction in the intraepidermal vacuolated cells, and a somewhat thicker horny layer. An ultrastructural study carried out at the same time showed a reduction in keratin bundles and keratohyalin granules, and an increase in lipid droplets up to the horny layer. These findings and the therapeutic response to topical calcipotriol support the concept that circumscribed palmar hypokeratosis is a focalized abnormal keratinization defect morphologically expressed at the granular and horny layers. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective The objective was to compare the effectiveness of psoralen plus ultraviolet A (PUVA) and the combination of PUVA and topical calcipotriol in the treatment of vitiligo. Background There are several reports on the response rate of patients with vitiligo treated with the combination of PUVA and calcipotriol or calcipotriol alone. Subjects and methods Twenty-two patients with generalized vitiligo were taken into the study. PUVA treatment was applied on a twice-weekly schedule. Calcipotriol cream was applied to one of the two symmetrical lesions of each patient twice daily. Results Our results showed that the addition of topical calcipotriol to PUVA treatment did not lead to a significant increase in response rate of patients with vitiligo compared with PUVA treatment alone. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to evaluate the efficacy and tolerability of the association of calcipotriol ointment (50 μg/g) plus cyclosporine versus cyclosporine alone in the treatment of moderate psoriasis (mean PASI: 13). Methods Twenty patients were enrolled in this right-left open study. All the patients admitted were treated with cylosporine at an initial dose of 4.5 mg/kg/day: in case of clinical improvement this dosage was reduced by 0.5 mg/kg/day every 15 days. In each patient we chose two similar, symmetrical lesions and calcipotriol ointment was applied only on the right lesion, twice a day, until the healing of the lesion or for 1 month. Patients were checked at baseline and even 15 days. Results Eighteen patients completed the study and 17 of the 18 presented more evident improvement on the side treated with combined therapy, while only one patient showed a better result on the side treated with cyclosporine alone. A significant difference of the total score was already present after 15 days of therapy and was confirmed at the following check-ups. Conclusions These results underline the usefulness of the association of calcipotriol and cyclosporine in order to decrease the total dosage of cyclosporine. [ABSTRACT FROM AUTHOR]

AbstractGougerot–Carteaud syndrome or confluent and reticulated papillomatosis (CRP), was first described by Gougerot and Carteaud as dermatosis.1,2 It is generally considered a rare condition. The eruption consists confluent, flat, brown papules localized primarily to the intermammary and interscapular regions with subsequent spread to the breast and abdomen; at the periphery, the papules spread out forming a pigmented reticulated pattern. At present, the aetiology of CRP remains unknown. The two prominent theories are an abnormal host response to fungi3 and a keratinization defect.4,5 Other hypothesis include photosensitivity,6 genetic factor,7 amylodosis cutis8 and endocrinopathy.9. [ABSTRACT FROM AUTHOR]

Abstract Objective Evaluation of the efficiency of topical calcipotriol monotherapy in vitiligo. Materials and methods This was a prospective, right/left comparative, open study at the Dermatology Department at the University Hospital in Nice, France. Twenty-four patients with localized or generalized vitiligo with symmetrical lesions were included. The main outcome measure was the evaluation of the percentage of repigmentation in treated target lesions and untreated control lesions for each patient. Results and conclusions Topical calcipotriol in monotherapy is not an effective treatment of vitiligo. [ABSTRACT FROM AUTHOR]