A Comparative Study to Evaluate Epidermal Barrier Integrity of Psoriasis Patients Treated With Calcipotriene/Betamethasone Topical Suspension Versus Betamethasone Dipropionate 0.05% Lotion
August 2017 | Volume 16 | Issue 8 | Original Article | 747 | Copyright © August 2017
Peter W. Hashim MD MHS,a John K. Nia MD,a David Terrano MD,a Gary Goldenberg MD,a and Leon H. Kircik MDa,b,c
aThe Icahn School of Medicine at Mount Sinai, Department of Dermatology, New York, NY bIndiana University School of Medicine, Indianapolis, IN cPhysicians Skin Care PLLC, Louisville, KY
Abstract
BACKGROUND: Topical corticosteroids are known to impair the epidermal barrier, even after short-term use, whereas topical vitamin D analogues can have a reparative effect. Combination products using corticosteroids and vitamin D analogues have gained popularity in recent years and may provide a means to minimize skin atrophy in patients treated with topical corticosteroids.
OBJECTIVE: To compare epidermal barrier function and cutaneous atrophy after 4 weeks of calcipotriene 0.005% and betamethasone dipropionate 0.064% topical suspension (Taclonex® TS) versus betamethasone dipropionate 0.05% lotion (Diprosone®).
METHODS: Ten subjects with moderate plaque psoriasis were enrolled. Patients were randomized to apply calcipotriene 0.005%/betamethasone dipropionate 0.064% once daily to psoriasis plaques on one side of the body and betamethasone dipropionate 0.05% lotion twice daily to plaques on the other side. Biopsies were performed at baseline and after four weeks of treatment to evaluate for epidermal and dermal changes.
RESULTS: Treatment with betamethasone lotion resulted in significant decreases in epidermal thickness and dermal thickness. In contrast, treatment with calcipotriene/betamethasone did not lead to significant decreases in epidermal thickness or dermal thickness. Comparing betamethasone and calcipotriene/betamethasone, there was a significantly greater reduction in epidermal thickness with betamethasone lotion versus calcipotriene/betamethasone (P less than .0001). Relative differences in dermal thickness and transepidermal water loss (TEWL) did not reach statistical significance.
CONCLUSION: This study is the first to demonstrate that treatment of plaque psoriasis with a combination topical corticosteriod and calcipotriene product results in greater preservation of the skin layers relative to topical corticosteroid use alone. These results hold important ramifications for minimizing cutaneous atrophy in patients receiving treatment with topical corticosteroids.
J Drugs Dermatol. 2017;16(8):747-752.
INTRODUCTION
Psoriasis is an immune-mediated in ammatory skin disorder characterized by hyperproliferation and poor differentiation of keratinocytes. The erythematous, scaly, and indurated plaques of psoriasis have significant cosmetic and functional impacts on patients, with lesions often cracking, bleeding, and causing significant pruritus.1 Topical therapies are a key treatment modality for psoriasis, as approximately 80% of patients rely solely on topical therapies.2 Although monoclonal antibodies have gained popularity for their safety and efficacy, use of these treatments is restricted to patients with extensive disease. The majority of psoriasis patients, however, have less than 3% of body surface area affected.3 As such, topical medications remain the preferred therapy for mild-to-moderate plaque psoriasis.4 Moreover, many patients on systemic treatment experience greater improvement with concurrent topical treatment.5 Topical corticosteroids are effective and widely used, but prolonged exposure is associated with numerous adverse events, particularly skin atrophy. Atrophy results from disruptions in hyaluronic acid structure and synthesis as well as inhibited synthesis of collagen and lipids, with these changes leading to abnormal dermal and epidermal structure, increased skin permeability, and increased transepidermal water loss (TEWL).6,7 The face and exural areas are particularly vulnerable to corticosteroid-induced damage.8 Although clinicians aim to limit extended exposure to topical corticosteroids, even short-term use can impair the epidermal barrier.9 Topical vitamin D analogues offer a means to help repair the epidermal barrier. Calcipotriene, a vitamin D3 analogue, has been shown to counteract the atrophogenic effects of betamethasone on collagen I synthesis, matrix metalloproteinase secretion, and hyaluronic acid production.10 Although the exact
