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Review
. 2005 Apr;51(4):519-25.

Topical therapies for psoriasis: evidence-based review

Tarek Afifi  1 , Gillian de Gannes, Changzheng Huang, Youwen Zhou
Affiliations
Review

Topical therapies for psoriasis: evidence-based review

Tarek Afifi et al. Can Fam Physician. 2005 Apr.

Abstract
in English, French

Objective: To review current understandings of and approaches to topical psoriasis therapies and to assess their efficacies and adverse effects.

Quality of evidence: Literature from 1987 to 2003, inclusive, was reviewed via MEDLINE using the search term "psoriasis" combined with "topical treatment." Articles were prioritized based on their level of evidence, favouring double-blind, randomized controlled trials over other comparison studies. Other studies were included where level I research was unavailable. No level III research was included.

Main message: Psoriasis is very common and causes substantial morbidity. Because most psoriasis is mild to moderate, patients are well suited to outpatient topical therapy. Advances in topical treatments for psoriasis have kept pace with a rapidly evolving comprehension of its pathogenesis, making a review of current therapies useful for those who treat psoriasis. While research supports continued reliance on corticosteroids as first-line therapy, comparable efficacy has been shown for vitamin D analogues and topical retinoids, albeit with a slight increase in adverse effects.

Conclusion: The combination of steroids and vitamin D analogues or topical retinoids is perhaps the most promising current treatment. It seems to have increased efficacy and fewer side effects.

OBJECTIF: Faire le point sur ce que l’on sait des différentes formes de traitement topique du psoriasis et évaluer leur efficacité et leurs effets indésirables.

QUALITÉ DES PREUVES: Une recherche a été effectuée dans MEDLINE de 1987 à 2003 inclusivement à l’aide des mots-clés « psoriasis » et « topical treatment » combinés. On a classé les articles repérés selon leur niveau de preuve, en favorisant les essais randomisés à double insu plutôt que les essais comparatifs. D’autres études ont été retenues lorsqu’il n’y avait pas de recherche de niveau I. Les recherches de niveau III ont été exclues.

PRINCIPAL MESSAGE: Le psoriasis est très fréquent et c’est une importante cause de morbidité. Comme la plupart des cas sont bénins ou modérés, les patients peuvent généralement bénéficier d’un traitement topique en externe. Le traitement topique du psoriasis a connu des progrès rapides parallèlement à l’amélioration des connaissances sur la pathogenèse du psoriasis, si bien qu’il est opportun de faire le point sur les modalités thérapeutiques actuelles. Même si les données actuelles préconisent toujours les corticostéroïdes comme traitement de première ligne, on a observé que les analogues de la vitamine D et les rétinoïdes topiques ont une efficacité comparable, quoiqu’ils aient un peu plus d’effets indésirables.

CONCLUSION: La combinaison de stéroïdes et d’analogues de la vitamine D ou de rétinoïdes topiques semble être le traitement le plus prometteur actuellement. Il semble avoir une efficacité accrue et moins d’effets secondaires.

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Conflict of interest statement

Competing interests: None declared

Figures

Figure 1
Figure 1. Appearance of psoriasis
A) Nail pitting; B) Lesions on the back; C) Inflammatory areas on the buttocks; D) Lesion on the back of the calf.
Figure 1
Figure 1. Appearance of psoriasis
A) Nail pitting; B) Lesions on the back; C) Inflammatory areas on the buttocks; D) Lesion on the back of the calf.
Figure 1
Figure 1. Appearance of psoriasis
A) Nail pitting; B) Lesions on the back; C) Inflammatory areas on the buttocks; D) Lesion on the back of the calf.
Figure 1
Figure 1. Appearance of psoriasis
A) Nail pitting; B) Lesions on the back; C) Inflammatory areas on the buttocks; D) Lesion on the back of the calf.
See this image and copyright information in PMC

Comment in

References

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