van de Kerkhof P C, Steegers-Theunissen R P, Kuipers M V
Department of Dermatology, University Hospital Nijmegen, The Netherlands.
Dermatology. 1998;197(1):31-6. doi: 10.1159/000017972.
During the last decade important innovations in the topical treatment of psoriasis have been accomplished, and important investments in new drug development for psoriasis are planned.
A survey was conducted among psoriatic patients in order to quantify the present mode of use of topical drugs by the patients, the mode of prescription by their doctors and the compatibility of actual use and instructions to the patients.
Major observations are: The distribution of lesions, in particular on the scalp and soles, justifies major investments in the development of a treatment at these locations. calcipotriol and topical corticosteroids (classes III and IV) are by far the most frequently prescribed topical drugs. Although at the time of investigation, Calcipotriol was only available as ointment in the Netherlands, it is prescribed twice as often as clobetasol which is both available as an ointment and cream. Dermatologists are responsible for approximately 2/3 and general practitioners for 1/3 of the prescriptions. The prescription by general practitioners also comprises the continuation of prescriptions by the dermatologist. The duration of topical treatment is unrestricted in the majority of patients. However, use of up to 8 weeks is only seldom practised. Therefore, long-term safety and efficacy data of these drugs are mandatory for any topical treatment. Although twice daily treatment was advised in 50% of all patients, this treatment frequency was followed in only 33% of them. Greasiness accounted for non-compliance in 11% of the patients. Less frequent applications were desired by 38% of the patients, including patients on a once-a-day regimen. Most patients preferred the cream formulation. However, the variability of the expression of psoriasis (dry cracked exudative or superficially scaling lesions) required the availability of both cream and ointment formulations.
An optimal treatment of psoriasis requires a spectrum of topical drugs and their formulations in different vehicles.
在过去十年间，银屑病局部治疗取得了重要进展，并且计划对银屑病新药研发进行重大投资。
对银屑病患者进行了一项调查，以量化患者目前局部用药的使用方式、医生的处方方式以及实际使用情况与给患者的用药说明的相符性。
主要观察结果如下：皮损的分布情况，尤其是头皮和足底的皮损，说明在这些部位的治疗研发方面进行重大投资是合理的。钙泊三醇和外用皮质类固醇（III类和IV类）是目前处方最多的局部用药。尽管在调查时，钙泊三醇在荷兰仅以软膏剂型供应，但它的处方量是氯倍他索的两倍，而氯倍他索既有软膏剂型也有乳膏剂型。皮肤科医生开具的处方约占2/3，全科医生开具的处方约占1/3。全科医生开具的处方还包括皮肤科医生处方的延续。大多数患者的局部治疗疗程不受限制。然而，很少有患者使用长达8周的治疗。因此，对于任何局部治疗而言，这些药物的长期安全性和有效性数据都是必不可少的。尽管50%的患者被建议每日用药两次，但只有33%的患者遵循了这种用药频率。11%的患者因油腻感而不依从治疗。38%的患者，包括每日用药一次的患者，希望减少用药频率。大多数患者更喜欢乳膏剂型。然而，银屑病表现形式的多样性（干燥皲裂、渗出或浅表鳞屑性皮损）需要同时有乳膏和软膏剂型可供使用。
银屑病的最佳治疗需要一系列不同剂型的局部用药及其制剂。
