Topical Treatments for Chronic Plaque Psoriasis of the Scalp: a Systematic Review

Mason, A.R.; Mason, J.M.; Cork, M.J.; Hancock, H.; Dooley, G.

Abstract

Background: Chronic plaque psoriasis is the most common type of psoriasis and is characterised by redness, thickness and scaling. First line management is with topical treatments. Objective: Our objective was to establish the effectiveness, tolerability and safety of topical treatments for people with chronic plaque psoriasis of the scalp, assessing placebo-controlled trials of all treatments and head-to-head trials that assessed vitamin D analogues. Methods: As part of a Cochrane review of topical treatments for psoriasis we systematically searched electronic databases for randomized controlled trials. The review included 26 randomised controlled trials of treatments for psoriasis of the scalp with 8,020 participants. Trials used several measures to assess changes in psoriasis severity: these were combined using the standardised mean difference metric and interpreted by reporting as a 6-point global improvement score. Results: On effectiveness grounds, very potent or potent steroid treatments should be preferred to vitamin D3 analogue with approximately an average 10% additional improvement on a 6-point scale. Vitamin D3 analogue combined with potent steroid appears slightly more effective than potent steroid monotherapy (3% additional improvement on a 6-point scale). Rates of withdrawal from treatment and adverse events in trials were generally low and similar to those for placebo. There remains uncertainty about the atrophic potential of corticosteroid treatments for scalp psoriasis. Conclusions: Corticosteroids are more effective than vitamin D analogues and similarly tolerated. 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 of the Scalp: a Systematic Review. British Journal of Dermatology, 169(3), 519-527. https://doi.org/10.1111/bjd.12393

• Journal Article Type: Article
• Publication Date: Sep 1, 2013
• Deposit Date: Aug 12, 2013
• Publicly Available Date: Jan 5, 2017
• Journal: British Journal of Dermatology
• Print ISSN: 0007-0963
• Electronic ISSN: 1365-2133
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 169
• Issue: 3
• Pages: 519-527
• DOI: https://doi.org/10.1111/bjd.12393
• Keywords: Psoriasis, Drug Administration, Topical, Treatment Outcome, Drug Safety
• Public URL: https://durham-repository.worktribe.com/output/1479920