Shokeen Divya, O'Neill Jenna L, Taheri Arash, Feldman Scott R
Wake Forest School of Medicine.
Dermatol Online J. 2014 Mar 17;20(3):doj_21762.
Topical corticosteroids are the primary treatment for scalp psoriasis. Keratolytic agents are promoted as adjunctive treatments. However, complex treatment regimens may result in poor adherence and outcomes.
To evaluate the evidence for the need for use of topical keratolytic agents as opposed to topical corticosteroid monotherapy in the treatment of scalp psoriasis.
A review of the literature was performed seeking clinical trials using topical keratolytics, topical corticosteroids or the combination for treatment of scalp psoriasis.
Complete clearance of scalp psoriasis can be achieved in 10-78% of patients using topical corticosteroids alone, in 3% of patients using topical keratolytics alone, and in up to 84% using a combination of topical keratolytics and topical steroids. Clinical trials comparing the combination of keratolytics and topical corticosteroids versus topical corticosteroids alone found marginally more efficacy using combination regimens.
We could not find any long term study evaluating the efficacy of combination therapy in scalp psoriasis and its effect on the patients' adherence.
High potency topical corticosteroids are usually effective in treating scalp psoriasis in clinical trials. Poor efficacy in clinical practice may be owing to poor adherence to the treatment regimen. Using a keratolytic agent in conjunction with a topical corticosteroid may provide marginal additional benefit in clinical trials, but that benefit is likely outweighed by the downside of complicating treatment and reducing adherence in the clinical setting, unless a single product containing both medications were used.
外用糖皮质激素是头皮银屑病的主要治疗方法。角质剥脱剂被推荐作为辅助治疗。然而，复杂的治疗方案可能导致依从性差和疗效不佳。
评估在头皮银屑病治疗中，与外用糖皮质激素单药治疗相比，使用外用角质剥脱剂的必要性的证据。
对文献进行综述，寻找使用外用角质剥脱剂、外用糖皮质激素或两者联合治疗头皮银屑病的临床试验。
单独使用外用糖皮质激素可使10%-78%的患者头皮银屑病完全清除，单独使用外用角质剥脱剂可使3%的患者完全清除，而外用角质剥脱剂与外用糖皮质激素联合使用可使高达84%的患者完全清除。比较角质剥脱剂与外用糖皮质激素联合治疗与单独外用糖皮质激素治疗的临床试验发现，联合治疗方案的疗效略高。
我们未能找到任何评估联合治疗在头皮银屑病中的疗效及其对患者依从性影响的长期研究。
在临床试验中，高效外用糖皮质激素通常对治疗头皮银屑病有效。临床实践中疗效不佳可能是由于对治疗方案的依从性差。在临床试验中，将角质剥脱剂与外用糖皮质激素联合使用可能会带来些许额外益处，但在临床环境中，这种益处可能会被治疗复杂化和依从性降低的不利影响所抵消，除非使用含有两种药物的单一产品。
