Ito Kotaro, Koga Monji, Shibayama Yoshitsugu, Tatematsu Saori, Nakayama Juichiro, Imafuku Shinichi
Department of Dermatology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
J Dermatol. 2016 Apr;43(4):402-5. doi: 10.1111/1346-8138.13158. Epub 2015 Oct 5.
Topical calcipotriol is a widely used treatment for plaque-type psoriasis worldwide, and has been shown to improve psoriatic plaques as well as very potent corticosteroids. However, there remains the practical question of whether calcipotriol application should continue on healed pigmentation/depigmentation associated with psoriatic plaques. Therefore, we conducted a pilot clinical study to answer this question. Plaque-type psoriatic patients not receiving systemic treatment were enrolled and treated with calcipotriol for 8 weeks (stage I) to achieve maximum effect. The patients were then divided into two groups: group A continued to apply calcipotriol to the entirety of the previous lesion (including pigmentation/depigmentation) regardless of whether skin was healed or not, while group B applied calcipotriol to the remaining lesion only. Patients were followed for 12 weeks (stage II) and dates of plaque recurrence were recorded. A total of 29 patients (13 men, 16 women) were enrolled. During stage I, reductions in scores for redness, induration and scale occurred in 40%, 47% and 55% of patients, respectively. After stage II was completed, group A (n = 19) showed a significantly better Kaplan-Meier curve of non-recurrence than group B (n = 8, P < 0.01). The mean non-recurrence duration was 76.8 ± 11.8 in group A and 35.0 ± 12.0 in group B. Our study showed that applying topical calcipotriol on seemingly healed psoriatic plaque lesions suppresses recurrence better than applying it only on remaining plaques. This finding may be important for instructing psoriatic patients on topical calcipotriol treatment.
外用卡泊三醇是全球广泛用于治疗斑块型银屑病的药物，已被证明能改善银屑病斑块，效果与强效皮质类固醇相当。然而，对于银屑病斑块愈合后出现的色素沉着/色素脱失，是否应继续使用卡泊三醇仍存在实际问题。因此，我们开展了一项初步临床研究来回答这个问题。纳入未接受全身治疗的斑块型银屑病患者，给予卡泊三醇治疗8周（第一阶段）以达到最大疗效。然后将患者分为两组：A组无论皮肤是否愈合，均继续在先前病变的整个区域（包括色素沉着/色素脱失处）涂抹卡泊三醇，而B组仅在剩余病变处涂抹卡泊三醇。对患者进行12周的随访（第二阶段），记录斑块复发日期。共纳入29例患者（13例男性，16例女性）。在第一阶段，分别有40%、47%和55%的患者出现红斑、硬结和鳞屑评分降低。第二阶段结束后，A组（n = 19）的无复发生存曲线明显优于B组（n = 8，P < 0.01）。A组的平均无复发持续时间为76.8 ± 11.8周，B组为35.0 ± 12.0周。我们的研究表明，在看似愈合的银屑病斑块病变上外用卡泊三醇比仅在剩余斑块上使用能更好地抑制复发。这一发现对于指导银屑病患者外用卡泊三醇治疗可能具有重要意义。
