Comparative Evaluation of Topical Calcipotriol Versus Coal Tar and Salicylic Acid Ointment in Chronic Plaque Psoriasis

August 2013 | Volume 12 | Issue 8 | Original Article | 868 | Copyright © 2013

Preeti Singh MD,a Surabhi Gupta MD,a Afroz Abidi MD,a and Arvind Krishna MDb

aDepartment of Clinical Pharmacology, Subharti Medical College, Meerut, India
bDepartment of Dermatology, Subharti Medical College, Meerut, India

Abstract

BACKGROUND: Calcipotriol is a newer topical treatment option available for plaque psoriasis and coal tar being one of the oldest treatment and still in use.
AIMS: To evaluate and compare the differences in terms of efficacy, safety and relapse with Calcipotriol 0.005% (50 mcg/gm) and 6% coal tar and 3% salicylic ointment in patients with Plaque psoriasis.
SETTING and DESIGNS: Study conducted on 60 patients of plaque psoriasis, who attended the skin OPD in our hospital.
METHODS: The patients with mild to moderate plaque psoriasis were selected. 60 patients were enrolled for the study after obtaining informed consent. Subjects were asked to apply Calcipotriol 0.005% (50 mcg/gm) (Heximar Win care) twice a day on the right side plaques and on left side plaques, Petroleum jelly (Vaseline) in the morning and 6% coal tar and 3% salicylic ointment (Protar® Percos) at nighttime. PASI score was used to assess the reponse to therapy at 2nd, 4th, 6th and 8th week. After treatment subjects were observed for 6 weeks for any relapse.
STATISTICAL ANALYSIS: It was done by paired t-test and independent sample t-test.
CONCLUSIONS: The results showed that statistically significant difference was seen in the mean percentage reduction of PASI score between both the groups, at all the assessment visits, 2, 4, 6, and 8 weeks, the mean percentage reduction at 2 weeks for calcipotriol being 21±12.06 and for coal tar being 13.44±11.19 (P=0.000), at 4 weeks for calcipotriol was 40±16.71 and for coal tar 25±99 (P=0.000), at 6 weeks for calcipotriol was 53.99+-22.43 and for coal tar 41±21.23 (P=0.002), at 8 weeks for calcipotriol was 62.73±24.04 and for coal tar was 51.53±23.27 (P=0.11). Relapse was seen in 5/60 (8.3%) of patients on calcipotriol treated side and 9/60 (15%) of patients with coal tar treated side. Thus it can be concluded that calcipotriol cream is more efficacious when compared with coal tar and does have a quick response. It is well tolerated and acceptable cosmetically.

J Drugs Dermatol. 2013;12(8):868-873.

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INTRODUCTION

Psoriasis is a common chronic inflammatory skin disease, with a strong genetic basis characterized by complex alterations in epidermal growth and differentiation. The disease is enormously variable in duration and extent. It affects 1-3% of the world population.1,2 Both the sex and all ethnic groups are equally affected. It is uncommon under the age of 10 years. It is most likely to appear between the ages of 15 to 30 years. Type I psoriasis, with age of onset before 40 years is HLA associated, and type II with age of onset after 40 years lacks HLA associations.3

The incidence of psoriasis in dermatology clinics and hospitals in India is 0.8% to 5.6%.2,4-7 Higher prevalence in males (2.4%) than in females (0.8%) was noted in most Indian studies8-9 but females develop psoriasis earlier than males.1 Kaur et al (1986) reported that the mean age of onset of females and males were 24.34±15.10 and 36.9±15.10 years, respectively.2

More than 80% of individuals who are diagnosed with psoriasis have mild disease affecting less than 3% body surface area (BSA). For these patients, topical therapies are the first line of treatment Conventional topical therapies include emollients, keratolytics, coal tar, corticosteroids, anthralin and the newer ones like PUVA, methotrexate, calcitriol, calcipotriol, tazoretene and ascomycin. Coal tar is one of the commonest, conventional treatment modality for psoriasis.10 Coal tar (5%-20%) is often combined with salicylic acid (2%-5%) and because of the keratolytic action of salicylic acid there is better absorption of coal tar.3 Calcipotriol provides a promising corticosteroid sparing topical therapy. Calcipotriol is being widely used as topical treatment modality for chronic plaque psoriasis in American and European countries.11 It has been approved as anti- psoriatic therapy by FDA in 1994 and Drug Controller in India in 1995.12

This study was planned to evaluate and compare the differences in terms of efficacy, safety and relapse with calcipotriol and coal tar. The hypothesis postulated was that calcipotriol may show an early response and may be more efficacious when compared to coal tar.

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