Topical treatments for chronic plaque psoriasis: an abridged Cochrane Systematic Review

Mason, A; Mason, JM; Cork, M; Hancock, H; Dooley, G

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.

Citation

Mason, A., Mason, J., Cork, M., Hancock, H., & Dooley, G. (2013). Topical treatments for chronic plaque psoriasis: an abridged Cochrane Systematic Review. Journal of The American Academy of Dermatology, 69(5), 799-807. https://doi.org/10.1016/j.jaad.2013.06.027

• Journal Article Type: Article
• Acceptance Date: Jun 2, 2013
• Online Publication Date: Oct 11, 2013
• Publication Date: Oct 11, 2013
• Deposit Date: Oct 31, 2013
• Publicly Available Date: Jan 6, 2017
• Journal: Journal of The American Academy of Dermatology
• Print ISSN: 0190-9622
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 69
• Issue: 5
• Pages: 799-807
• DOI: https://doi.org/10.1016/j.jaad.2013.06.027
• Public URL: https://durham-repository.worktribe.com/output/1447766