Topical treatments for chronic plaque psoriasis: An abridged Cochrane Systematic Review - 23/10/13
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.
Le texte complet de cet article est disponible en PDF.Key words : drug administration, drug safety, psoriasis, review, topical, treatment outcome
Abbreviations used : BD, CI, IAGI, OD, SD, SMD
Plan
Supported by the Psoriasis Association, United Kingdom. |
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Disclosure: In 2012, Professor Cork gave a lecture for Leo Pharmaceuticals about psoriasis and atopic eczema. Ms Mason and Professor Mason, Dr Hancock, and Dr Dooley have no conflicts of interest to declare. |
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Disclaimer: The results of a Cochrane review can be interpreted differently, depending on people's perspectives and circumstances. The conclusions presented are the opinions of review authors, and are not necessarily shared by the Cochrane Collaboration. |
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Reprints not available from the authors. |
Vol 69 - N° 5
P. 799-807 - novembre 2013 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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