Medical Health Encyclopedia

Application. Anthralin should be applied only to the psoriasis plaques. Many people use disposable gloves to avoid staining hands. The areas can usually be protected with dressings. Rub the cream in well and wipe off any excess. Wash off only with lukewarm water, not soap. (Using hot water will trigger the staining action.) A technique called short-contact anthralin therapy (SCAT), also called minute therapy, is useful for local areas of psoriasis. In such cases, anthralin is applied for only 10 minutes to an hour.

Topical Vitamin D3 Analogs

A topical form of vitamin D3, calcipotriene (Dovonex), called calcipotriol in Europe, is proving to be both safe and effective. It is now available in a foam preparation, which makes compliance even easier. Several other topical vitamin D3 analogs, showing promise include maxacalcitol (Oxarol), tacalcitol, and calcitriol (Silkis), the active form of vitamin D.

Benefits. Calcipotriene has the following benefits:

• It appears to help block skin cell proliferation.
• It enhances the maturity of keratinocytes (the impaired skin cell in psoriasis).
• It has anti-inflammatory properties.

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It is at least as effective as moderate topical corticosteroids, short contact anthralin, and coal tar in improving mild to moderate plaque psoriasis. Unlike steroids, patients do not develop thinning of the skin or tolerance to the drug.

Combinations. Combinations with other topical and oral treatments may improve effectiveness.

• Calcipotriene is not as effective as the highest potency corticosteroids, but products or regimens that combine both agents are proving to be more effective than either agent alone. For example, an ointment that combines calcipotriene with betamethasone (Daivobet) may prove more effective than either agent alone.
• Studies also report success in some patients who use vitamin D ointments in combination with the phototherapy treatment.
• Combining vitamin D ointments with oral agents, notably methotrexate, acitretin, or cyclosporine, increases effectiveness and allows lower doses or either medication, thereby reducing side effects.