Psoriasis is treated by topical Vitamin D, etc.

Created May 2023

Topical treatment of psoriasis vulgaris

J Dtsch Dermatol Ges . 2023 May 26. doi: 10.1111/ddg.15042   PDF is behind a paywall

Lejla Ramic 1, Paul Sator 1

Topical therapy plays an important role in the treatment of psoriasis. It is the gold standard in mild psoriasis cases and is also recommended in addition to UV and systemic therapy in cases of moderate to severe psoriasis. In this overview article we summarize the current therapeutic options, taking into account special localizations (scalp, facial, intertriginous/genital, or palmoplantar lesions) and situations (hyperkeratotic or inflammatory forms), as well as the therapy options during pregnancy and breastfeeding. In the initial phase, the combination of topical corticosteroids and vitamin D analogues has proven to be the therapy of choice, as well as monotherapy in each case. In maintenance therapy, fixed combination therapy is recommended once or twice a week. In addition to the right choice of active substances, the choice of the right formulation also plays an important role.

To increase adherence, it is very important to consider the personal preferences and experiences of the patient. If topical therapy does not lead to a satisfactory result, additional UV therapy or systemic therapy should be considered.

56 References

  1. Nast A, Altenburg A, Augustin M, et al. German S3-Guideline on the treatment of Psoriasis vulgaris, adapted from EuroGuiDerm - Part 1: Treatment goals and treatment recommendations. J Dtsch Dermatol Ges. 2021;19(6):934-1150.

  2. Armstrong AW, Read C. Pathophysiology, clinical presentation, and treatment of psoriasis: a review. J Am Med Assoc. 2020;323(19):1945-1960.

  3. Boehncke WH, Schön MP. Psoriasis. Lancet. 2015;386(9997):983-994.

  4. Mrowietz U, Kragballe K, Reich K, et al. Definition of treatment goals for moderate to severe psoriasis: A European consensus. Arch Dermatol Res. 2011;303(1):1-10.

  5. Langenbruch A, Radtke MA, Jacobi A, et al. Quality of psoriasis care in Germany: results of the national health care study “PsoHealth3”. Arch Dermatol Res. 2016;308(6):401-408.

  6. Devaux S, Castela A, Archier E, et al. Adherence to topical treatment in psoriasis: a systematic literature review. J Eur Acad Dermatol Venereol. 2012;26(Suppl 3):61-67.

  7. Luger T, Seite S, Humbert P, et al. Recommendations for adjunctive basic skin care in patients with psoriasis. Eur J Dermatol. 2014;24(2):194-200.

  8. Fluhr JW, Cavallotti C, Berardesca E. Emollients, moisturizers, and keratolytic agents in psoriasis. Clin Dermatol. 2008;26(4):380-386.

  9. M Lebwohl. The role of salicylic acid in the treatment of psoriasis. Int J Dermatol. 1999;38(1):16-24.

  10. Taylor JR, Halprin KM. percutaneous absorption of salicylic acid. Arch Dermatol. 1975;111(6):740-743.

  11. Lew BL, Cho Y, Kim J, et al. Ceramides and cell signaling molecules in psoriatic epidermis: reduced levels of ceramides, PKC-alpha, and JNK. J Korean Med Sci. 2006;21(1):95-99.

  12. Vavrova K, Hrabalek A, Mac-Mary S, et al. Ceramide analogues 142S4 selectively recovers perturbed human skin barrier. Br J Dermatol. 2007; 157(4): 704-712.

  13. Levine D, Even-Chen Z, Lipets I, et al. Pilot, multicenter, double-blind, randomized placebo-controlled bilateral comparative study of a combination of calcipotriene and nicotinamide for the treatment of psoriasis. J Am Acad Dermatol. 2010;63(5):775-781.

  14. Choudhary V, Kaddour-Djebbar I, Custer VE, et al. Glycerol improves skin lesion development in the imiquimod mouse model of psoriasis: experimental confirmation of anecdotal reports from patients with psoriasis. Int J Mol Sci. 2021;22(16):8749.

  15. Seite S. Thermal waters as cosmeceuticals: La Roche-Posay thermal spring water example. Clin Cosmet Investig Dermatol. 2013;6:23-28.

  16. Siegfried EC, Jaworski JC, Kaiser JD, Hebert AA. Systematic review of published trials: long-term safety of topical corticosteroids and topical calcineurin inhibitors in pediatric patients with atopic dermatitis. BMC Pediatr. 2016;16:75.

  17. Douglas WS, Poulin Y, Decroix J, et al. A new calcipotriol/betamethasone formulation with rapid onset of action was superior to monotherapy with betamethasone dipropionate or calcipotriol in psoriasis vulgaris. Acta Derm Venereol. 2002;82:131-135.

  18. Papp KA, Guenther L, Boyden B, et al. Early onset of action and efficacy of a combination of calcipotriene and betamethasone dipropionate in the treatment of psoriasis. J Am Acad Dermatol. 2003;48:48-54.

  19. Gottlieb AB, Ford RO, Spellman MC. The efficacy and tolerability of clobetasol propionate foam 0.05% in the treatment of mild to moderate plaque-type psoriasis of nonscalp regions. J Cutan Med Surg. 2003;7:185-192.

  20. Weston WL, Fennessey PV, Morelli J, et al. Comparison of hypothalamus-pituitary-adrenal axis suppression from superpotent topical steroids by standard endocrine function testing and gas chromatographic mass spectrometry. J Invest Dermatol. 1988;90:532-535.

  21. Wilsmann-Theis D, Gerdes S, Körber A, et al. Topische Therapie der Psoriasis.1. Auflage, Bremen: UNI-MED, 2016.

  22. Gerritsen MJ, Van De Kerkhof PC, Langner A. Long-term safety of topical calcitriol 3 microg g(-1) ointment. Br J Dermatol. 2001;144(Suppl 58):17-19.

  23. Amichai B. Psoriasis of the glans penis in a child successfully treated with Elidel (pimecrolimus) cream. J Eur Acad Dermatol Venereol. 2004;18(6):742-743.

  24. Freeman AK, Linowski GJ, Brady C, et al. Tacrolimus ointment for the treatment of psoriasis on the face and intertriginous areas. J Am Acad Dermatol. 2003;48(4):564-568.

  25. Gribetz C, Ling M, Lebwohl M, et al. Pimecrolimus cream 1% in the treatment of intertriginous psoriasis: A double-blind, randomized study. J Am Acad Dermatol. 2004;51(5):731-738.

  26. Remitz A, Reitamo S, Erkko P, et al. Tacrolimus ointment improves psoriasis in a microplaque assay. Br J Dermatol. 1999;141(1):103-107.

  27. Zonneveld IM, Rubins A, Jablonska S, et al. topical tacrolimus is not effective in chronic plaque psoriasis. A pilot study. Arch Dermatol. 1998;134(9):1101-1102.

  28. Weischer M, Röcken M, Berneburg M. Calcineurin inhibitors and rapamycin: cancer protection or promotion? Exp Dermatol. 2007;16(5):385-393.

  29. Reitamo S, Rissanen J, Remitz A, et al. Tacrolimus ointment does not affect collagen synthesis: results of a single-center randomized trial. J Invest Dermatol. 1998;111(3):396-398.

  30. Lebwohl M, Freeman AK, Chapman MS, et al. Tacrolimus ointment is effective for facial and intertriginous psoriasis. J Am Acad Dermatol. 2004;51(5):723-730.

  31. Doelker L, Tran C, Gkomouzas A, et al. Production and clearance of cyclobutane dipyrimidine dimers in UV-irradiated skin pretreated with 1% pimecrolimus or 0.1% triamcinolone acetonide creams in normal and atopic patients. Exp Dermatol. 2006;15:342-346.

  32. Mrowietz U, Jessat H, Schwarz A, Schwarz T. Anthralin (dithranol) in vitro inhibits human monocytes to secrete IL-6, IL-8 and TNF-α, but not IL-1. Br J Dermatol. 1997;136(4):542-547.

  33. Painsi C, Patscheider M, Inzinger M, et al. Die Behandlung der Psoriasis mit klassischer, stationärer Dithranol-Therapie: eine retrospektive Patientenbefragung. J Dtsch Dermatol Ges. 2015;13(11):1156-1163.

  34. Vtama (tapinarof) cream, for topical use. US FDA approved product information; Long Beach, CA: Dermavant Sciences, Inc, 2022.

  35. Lebwohl MG, Stein Gold L, Strober B, et al. Phase 3 trials of tapinarof cream for plaque psoriasis. N Engl J Med. 2021;385:2219.

  36. Lebwohl MG, Papp KA, Stein Gold L, et al. Trial of roflumilast cream for chronic plaque psoriasis. N Engl J Med. 2020;383(3):229-239.

  37. Körber A, Wilsmann-Theis D, Augustun M, et al. Topische Therapie bei Psoriasis vulgaris - ein Behandlungspfad. J Dtsch Dermatol Ges. 2019;17(Suppl 4):3-14.

  38. Ruzicka T, Lorenz B. Comparison of calcipotriol monotherapy and a combination of calcipotriol and betamethasone valerate after 2 weeks’ treatment with calcipotriol in the topical therapy of psoriasis vulgaris: a multicentre, double-blind, randomized study. Br J Dermatol. 1998;138(2):254-258.

  39. Kragballe K, Barnes L, Hamberg KJ, et al. Calcipotriol cream with or without concurrent topical corticosteroid in psoriasis: tolerability and efficacy. Br J Dermatol. 1998;139(4):649-654.

  40. Radtke MA, Herberger K, Kornek T, Augustin M. [Calcipotriol plus betamethasone dipropionate gel in the treatment of scalp psoriasis. A review]. Hautarzt. 2010;61(9):770-775.

  41. Leonardi C, Bagel J, Yamauchi P, Pariser D, et al. Efficacy and safety of calcipotriene plus betamethasone dipropionate aerosol foam in patients with psoriasis vulgaris - a randomized phase III study (PSO-FAST). J Drugs Dermatol. 2015;14(12):1468-1477.

  42. Lebwohl M, Tyring S, Bukhalo M, et al. Fixed combination aerosol foam calcipotriene 0.005% (cal) plus betamethasone dipropionate0.064% (bd) is more efficacious than Cal or BD aerosol foam alone for psoriasis vulgaris: a randomized, double-blind, multicenter, three-arm, phase 2 study. J Clin Aesthet Dermatol. 2016;9(2):34.

  43. Koo J, Tyring S, Werschler WP, et al. Superior efficacy of calcipotriene and betamethasone dipropionate aerosol foam versus ointment in patients with psoriasis vulgaris - A randomized phase II study. J Dermatolog Treat. 2016;27(2):120-127.

  44. Paul C, Stein Gold L, Cambazard F, et al. Calcipotriol plus betamethasone dipropionate aerosol foam provides superior efficacy vs. gel in patients with psoriasis vulgaris: randomized, controlled PSO-ABLE study. J Eur Acad Dermatol Venereol. 2017;31(1):119-126.

  45. Lind M, Nielsen KT, Schefe LH, et al. Supersaturation of calcipotriene and betamethasone dipropionate in a novel aerosol foam formulation for topical treatment of psoriasis provides enhanced bioavailability of the active ingredients. Dermatol Ther (Heidelb). 2016;6(3):413-425.

  46. Samarasekera EJ, Sawyer L, Wonderling D, et al. topical therapies for the treatment of plaque psoriasis: systematic review and network metaanalyses. Br J Dermatol. 2013;168(5):954-967.

  47. Mason AR, Mason J, Cork M, et al. topical treatments for chronic plaque psoriasis. Cochrane database Syst Rev. 2009;(2):CD005028.

  48. Saraceno R, Camplone G, D'Agostino M, et al. Efficacy and maintenance strategies of two-compound formulation calcipotriol and betamethasone dipropionate gel (Xamiol® gel) in the treatment of scalp psoriasis: results from a study in 885 patients. J Dermatolog Treat. 2014;25(1):30-33.

  49. Stein Gold L, Alonso-Llamazares J, Lacour JP, et al. PSO-LONG: Design of a novel, 12-month clinical trial of topical , proactive maintenance with twice-weekly Cal/BD foam in psoriasis. Adv Ther. 2020;37(11):4730-4753.

  50. van de Kerkhof PC, de Hoop D, de Korte J, Kuipers MV. Scalp psoriasis, clinical presentations and therapeutic management. Dermatology. 1998;197(4):326-334.

  51. Schlager JG, Rosumeck S, Werner RN, et al. topical treatments for scalp psoriasis: summary of a Cochrane Systematic Review. Br J Dermatol. 2017;176(3):604-614.

  52. Schlager JG, Rosumeck S, Werner RN, et al. topical treatments for scalp psoriasis. Vol. 2016, Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd. 2016;2:CD009687.

  53. Chan CS, Van Voorhees AS, Lebwohl MG, et al. Treatment of severe scalp psoriasis: From the Medical Board of the National Psoriasis Foundation. J Am Acad Dermatol. 2009;60(6):962-971.

  54. Jacobi A, Braeutigam M, Mahler V, et al. Pimecrolimus 1% cream in the treatment of facial psoriasis: A 16-week open-label study. Dermatology. 2008;216(2):133-136.

  55. Jiaravuthisan MM, Sasseville D, Vender RB, et al. Psoriasis of the nail: Anatomy, pathology, clinical presentation, and a review of the literature on therapy. J Am Acad Dermatol. 2007;57(1):1-27.

  56. Williamson L, Dalbeth N, Dockerty JL, et al. Extended report: nail disease in psoriatic arthritis - clinically important, potentially treatable and often overlooked. Rheumatology (Oxford). 2004;43(6):790-794.

  57. De Berker D. Management of psoriatic nail disease. Semin Cutan Med Surg. 2009;28(1):39-43.

  58. Pasch MC. Nail Psoriasis: A review of treatment options. Drugs. 2016;76(6):675-705.

  59. Rigopoulos D, Gregoriou S, Daniel Iii CR, et al. Treatment of nail psoriasis with a two-compound formulation of calcipotriol plus betamethasone dipropionate ointment. Dermatology. 2009;218(4):338-341.

  60. Rigopoulos D, Ioannides D, Prastitis N, Katsambas A. Nail psoriasis: a combined treatment using calcipotriol cream and clobetasol propionate cream. Acta Derm Venereol. 2002;82(2):140.

  61. Tzung TY, Chen CY, Yang CY, et al. Calcipotriol used as monotherapy or combination therapy with betamethasone dipropionate in the treatment of nail psoriasis. Acta Derm Venereol. 2008;88(3):279-280.

  62. Chi CC, Wang SH, Mayon-White R, Wojnarowska F. Pregnancy outcomes after maternal exposure to topical corticosteroids : a UK population-based cohort study. JAMA dermatology. 2013;149(11):1274-1280.

  63. Gottlieb AB, Ryan C, Murase JE. Clinical considerations for the management of psoriasis in women. Int J women's dermatology. 2019;5(3):141-150.

  64. Chi C., Wang SH, Wojnarowska F, et al. Safety of topical corticosteroids in pregnancy. Cochrane database Syst Rev. 2015;2015(10).

  65. Murase JE, Heller MM, Butler DC. Safety of dermatologic medications in pregnancy and lactation: Part I. Pregnancy. J Am Acad Dermatol. 2014;70(3):401.e1-401.e14.

  66. Vestergaard C, Wollenberg A, Barbarot S, et al. European task force on atopic dermatitis position paper: treatment of parental atopic dermatitis during preconception, pregnancy and lactation period. J Eur Acad Dermatol Venereol. 2019;33(9):1644-1659.

Founder of Vitamin D Life on Topical vitamin D for psoraisis

Have been using it for over a decade for small psorasis on my right knee (bik injury)

About 3 times a year I notice it again and re-apply a few drops of nanoemulsion Vitamin D (10,000 IU)

My wife also uses it for skin problems - but washes it off after about 10 minutes . She does not like the sticky feel

Vitamin D Life – Topical Vitamin D category contains

{include}

Vitamin D Life – Psoriasis category contains

{include}

Renu Mahtani on oral treatment of Psorasis with Vitamin D

{include}

Vitamin D Life – Nanoemulsion Vitamin D may be a substantially better form updated March 2019

{include}

{include}