[Topical corticosteroids and corticosteroid sparing therapy in psoriasis management]

Abstract

Psoriasis is a chronic, recurrent, genetically determined, inflammatory dermatosis that affects the skin, scalp and joints. Psoriasis is caused by various triggers (infections, drugs, physical and emotional factors). It ranges in severity from mild to severe, and patients with moderate to severe disease suffer significant deterioration in the quality of life. Clinical types of psoriasis are psoriasis guttata, nummular psoriasis, plaque, generalized and erythrodermic psoriasis. Skin changes affect intertriginous regions (inverse psoriasis), and there also are special forms of pustular psoriasis and arthropathic psoriasis. The goals of psoriasis treatment are to gain initial and rapid control of the disease; to decrease plaque lesions and percentage of body surface area involved, to achieve long-term remission; and to minimize adverse events. Topical treatment for mild psoriasis includes topical corticosteroids, calcipotriene, tazarotene, topical tars, anthralin and keratolytics, and immunomodulators (pimecrolimus, tacrolimus). The treatment of moderate to severe psoriasis includes systemic therapies such as methotrexate, acitretin, cyclosporine, hydroxurea and biologicals. Topical treatment can be effective using combination, rotational or sequential regimens for patients with more severe disease. The aim of successful treatment of psoriasis is fast control of the disease and regression of lesions in a short period, prolonged remission and minimal adverse reaction. Local therapy with various topicals is administered for mild and localized forms of the disease, with or without phototherapy (UVB). Topical corticosteroids are used in a variety of formulations, with a potential ranging from superpotent to least potent (class 1-7), which decrease symptoms in tne first two weeks of treatment with improvement in subsequent weeks; D3 vitamin analog (effective in 6-8 weeks), retinoids (effective in 1-2 weeks), tars (2-4 weeks), anthralin (2-4 weeks), and keratolytics (most effective in combination with corticosteroids. Topical corticosteroids have been the first choice in the treatment of and inflammatory dermatoses since 1952 to the present. Corticosteroids are effective as monotherapy or in combination for sequential or rotational treatment. They are effective in short time, simple for use and inexpensive. Psoriasis is a chronic skin disease that requires long-term therapy. For patients with mild to moderate form, intermittent corticosteroid therapy is the most effective treatment. Every-other-day or weekend-only application may be effective in chronic stage. Calcipotriene and tazarotene are more effective in combination with corticosteroids in the initial weeks of therapy. Tar preparations, anthralin and keratolytics may be used with ultraviolet light and corticosteroids. Topical immunomodulators are effective on the face and intertriginous psoriatic lesions.