Pretreatment with an Aerosol Foam Containing Calcipotriene and Betamethasone Strongly Improves the Efficacy of Narrow-Band UVB Phototherapy

Abstract

Background: Narrow-band (NB) UVB has been combined with a number of topical treatments. However, there have been no specific data regarding treatment results of a fixed combination of calcipotriene 50 μg/g plus betamethasone 0.5 mg/g aerosol foam (Cal/BD) combined with NB-UVB phototherapy so far.

Objectives: To assess the efficacy of Cal/BD foam coupled to twice-weekly NB-UVB and whether this combined regimen requires fewer UVB treatments and a lower cumulative UVB dose compared to phototherapy alone.

Methods: This cross-sectional, prospective, parallel-group study enrolled 187 consecutive moderate-to-severe psoriatic patients who were allocated to two groups in a 1:2 ratio. The overall duration of the treatment cycle was 12 weeks. At baseline and after 2, 4, 8 and 12 weeks, we registered the modified (not considering head lesions) PASI, the number of Cal/BD applications, the NRS score for itching and the adverse effects.

Results: The combined regimen was more effective in clearing psoriasis [final mPASI: 2.1 (0; 8.2) versus 4.4 (0; 19.6); p < 0.01] and reducing itching [(final NRS score for itching: 0 (0; 3) versus 1 (0; 4); p < 0.01]. Fewer exposures [12 (4; 20) versus 24 (8; 24); p < 0.01] and a lower cumulative UVB dose [6.1 (5.4; 9.3) J cm^-2 versus 13.1 (9.8; 19.7) J cm^-2; p < 0.01] were required. A higher number of patients achieved complete clearance [47 (74.6%) versus 58 (46.8%) patients (p < 0.001)]. Both treatments were well tolerated without acute adverse effects.

Conclusion: Cal/BD + NB-UVB is a very effective treatment that produces a rapid improvement in clinical lesions and itching and can be considered a valuable alternative to systemic treatments for psoriasis.

Keywords: Betamethasone; Calcipotriene; Combined regimen; NB-UVB; Narrow-band UVB phototherapy; Psoriasis.

Fig. 1

Box plot of median (IQR) mPASI at baseline (T0) and after 4 (T2), 8 (T3) and 12 (T4) weeks in the two groups. In both groups, mPASI values at T2, T3 and T4 were always significantly lower (p < 0.001, Mann–Whitney test) in comparison to the baseline mPASI value. The symbol * indicates an outlier, i.e. a data point that is located outside the whiskers of the box

Fig. 2

A psoriatic plaque at baseline (a); a decrease in scaling and infiltrate was observed after 2 weeks of application of Cal/BD foam (b), and only mild erythema persisted after 2 further weeks of combined treatment with Cal/BD and phototherapy (c)

Fig. 3

Median NRS scores for itching at baseline (T0) and after 4 (T2), 8 (T3) and 12 (T4) weeks in the two groups