Lebwohl M G, Breneman D L, Goffe B S, Grossman J R, Ling M R, Milbauer J, Pincus S H, Sibbald R G, Swinyer L J, Weinstein G D, Lew-Kaya D A, Lue J C, Gibson J R, Sefton J
Mount Sinai Hospital, New York, NY 10029, USA.
J Am Acad Dermatol. 1998 Oct;39(4 Pt 1):590-6. doi: 10.1016/s0190-9622(98)70008-8.
Topical corticosteroids are often used in the treatment of psoriasis, but long-term use may be associated with serious adverse events such as tachyphylaxis or atrophy of the skin. Tazarotene, a new topical retinoid, has demonstrated significant clinical benefits but can cause mild to moderate local irritation.
We evaluate whether a combination treatment of topical tazarotene and a topical corticosteroid would increase efficacy while reducing the incidence of local adverse events associated with a topical retinoid.
Three hundred patients enrolled in an investigator-masked study were randomly assigned to 1 of 4 treatment groups: tazarotene 0.1% gel in combination with placebo cream, or with a low-, mid-, or high-potency corticosteroid cream, for 12 weeks of treatment and a posttreatment follow-up at week 16.
Tazarotene 0.1% gel in combination with a mid- or high-potency corticosteroid, when compared with tazarotene plus placebo cream, achieved significantly greater reductions in scaling, erythema, and overall lesional severity, and a decreased incidence of adverse events.
All tazarotene combinations (including tazarotene plus placebo) were highly effective in rapidly reducing the severity of psoriasis. Combining tazarotene with a topical corticosteroid increased efficacy while reducing the incidence of local adverse events.
局部用皮质类固醇常用于治疗银屑病,但长期使用可能与速发耐受或皮肤萎缩等严重不良事件相关。他扎罗汀是一种新型局部用维甲酸,已显示出显著的临床益处,但可引起轻至中度局部刺激。
我们评估局部用他扎罗汀与局部用皮质类固醇联合治疗是否会提高疗效,同时降低与局部用维甲酸相关的局部不良事件的发生率。
300名参与研究者设盲研究的患者被随机分配至4个治疗组中的1组:0.1%他扎罗汀凝胶联合安慰剂乳膏,或联合低、中、高效皮质类固醇乳膏,进行12周治疗,并在第16周进行治疗后随访。
与他扎罗汀加安慰剂乳膏相比,0.1%他扎罗汀凝胶联合中效或高效皮质类固醇在鳞屑、红斑和整体皮损严重程度方面的改善显著更大,且不良事件发生率降低。
所有他扎罗汀联合用药方案(包括他扎罗汀加安慰剂)在迅速降低银屑病严重程度方面均非常有效。他扎罗汀与局部用皮质类固醇联合使用可提高疗效,同时降低局部不良事件的发生率。