Hashim Peter W, Nia John K, Terrano David, Goldenberg Gary, Kircik Leon H
J Drugs Dermatol. 2017 Aug 1;16(8):747-752.
Topical corticosteroids are known to impair the epidermal barrier, even after short-term use, whereas topical vitamin D analogues can have a reparative effect. Combination products using corticosteroids and vitamin D analogues have gained popularity in recent years and may provide a means to minimize skin atrophy in patients treated with topical corticosteroids. OBJECTIVE: To compare epidermal barrier function and cutaneous atrophy after 4 weeks of calcipotriene 0.005% and betamethasone dipropionate 0.064% topical suspension (Taclonex® TS) versus betamethasone dipropionate 0.05% lotion (Diprosone®). METHODS: Ten subjects with moderate plaque psoriasis were enrolled. Patients were randomized to apply calcipotriene 0.005%/betamethasone dipropionate 0.064% once daily to psoriasis plaques on one side of the body and betamethasone dipropionate 0.05% lotion twice daily to plaques on the other side. Biopsies were performed at baseline and after four weeks of treatment to evaluate for epidermal and dermal changes. RESULTS: Treatment with betamethasone lotion resulted in significant decreases in epidermal thickness and dermal thickness. In contrast, treatment with calcipotriene/betamethasone did not lead to significant decreases in epidermal thickness or dermal thickness. Comparing betamethasone and calcipotriene/betamethasone, there was a significantly greater reduction in epidermal thickness with betamethasone lotion versus calcipotriene/betamethasone (P less than .0001). Relative differences in dermal thickness and transepidermal water loss (TEWL) did not reach statistical significance. CONCLUSION: This study is the first to demonstrate that treatment of plaque psoriasis with a combination topical corticosteriod and calcipotriene product results in greater preservation of the skin layers relative to topical corticosteroid use alone. These results hold important ramifications for minimizing cutaneous atrophy in patients receiving treatment with topical corticosteroid .
已知局部用皮质类固醇即使短期使用也会损害表皮屏障，而局部用维生素D类似物可能具有修复作用。近年来，使用皮质类固醇和维生素D类似物的复方产品越来越受欢迎，可能为减少局部用皮质类固醇治疗患者的皮肤萎缩提供一种方法。目的：比较0.005%卡泊三烯和0.064%二丙酸倍他米松局部混悬液（Taclonex®TS）与0.05%二丙酸倍他米松洗剂（Diprosone®）治疗4周后的表皮屏障功能和皮肤萎缩情况。方法：招募10名中度斑块状银屑病患者。患者被随机分配，在身体一侧的银屑病斑块上每日一次外用0.005%卡泊三烯/0.064%二丙酸倍他米松，在另一侧的斑块上每日两次外用0.05%二丙酸倍他米松洗剂。在基线和治疗4周后进行活检，以评估表皮和真皮变化。结果：二丙酸倍他米松洗剂治疗导致表皮厚度和真皮厚度显著降低。相比之下，卡泊三烯/二丙酸倍他米松治疗未导致表皮厚度或真皮厚度显著降低。比较二丙酸倍他米松和卡泊三烯/二丙酸倍他米松，二丙酸倍他米松洗剂导致的表皮厚度降低显著大于卡泊三烯/二丙酸倍他米松（P小于0.0001）。真皮厚度和经表皮水分流失（TEWL）的相对差异未达到统计学意义。结论：本研究首次证明，与单独使用局部皮质类固醇相比，使用局部皮质类固醇和卡泊三烯复方产品治疗斑块状银屑病能更好地保留皮肤各层。这些结果对于减少接受局部皮质类固醇治疗患者的皮肤萎缩具有重要意义。
