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SHORT COMMUNICATION
Year : 1991  |  Volume : 57  |  Issue : 6  |  Page : 307-308

Topical corticosteroid pulse therapy in psoriasis




Correspondence Address:
Y C Minocha


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How to cite this article:
Minocha Y C, Sood V K, Singh D, Minocha K B. Topical corticosteroid pulse therapy in psoriasis. Indian J Dermatol Venereol Leprol 1991;57:307-8

How to cite this URL:
Minocha Y C, Sood V K, Singh D, Minocha K B. Topical corticosteroid pulse therapy in psoriasis. Indian J Dermatol Venereol Leprol [serial online] 1991 [cited 2019 Oct 20];57:307-8. Available from: http://www.ijdvl.com/text.asp?1991/57/6/307/3717


Topical corticosteroid pulse therapy com­prises of intermittent use of superpotent cor­ticosteroids. Prolonged continuous therapy with such agents in patients with psoriasis results in certain side effects e.g. telangiectasis and cutaneous atrophy, [1] hypo­thalamic-pituitary-adrenal (HPA) axis suppres­sion [2] and tachyphylaxis, [3] whereas intermittent therapy may achieve beneficial effects for maintenance of remissions with an advantage of diminishing the side effects and total cost of medication.

In this study, 40 patients with psoriasis presenting as discoid plaques were included to evaluate the efficacy of topical pulse therapy with clobetasol propionate (0.05%). In each patient, a solitary test site lesion was selected and scored in terms of 'erythema', 'induration; and 'scaling' grading each sign from score of '0' to '3'. The total area of the target lesion was measured before starting the therapy and at subsequent follow up visits. Adjusted clinical scores (ACS) were calculated using following formula.

Erythema + Induration + Scaling

(0-3) (0-3) (0-3)

x % age of original area

Initially, all the patients were treated with daily topical application of clobetasol propi­onate (0.05%) for a period of 3 weeks and patients showing improvement of more than 85% in their ACS were submitted to topical pulse therapy by weekly topical treatment with three consecutive applications at 12 hourly intervals. Clinical evaluation and target area measurements were performed every 2 weeks for a period of 12 weeks. A patient was con­sidered to be a treatment failure if the ACS of target lesion was greater than 35% of the repulse therapy baseline assessment.

Out of 40 patients treated with a single topical application of clobetasol propionate (0.05%) daily for 3 weeks, 26 patients achieved at least 85% improvement of the target area as compared with the baseline. During topical pulse therapy of these 26 pa­tients 5 patients dropped out and 14 out of 21 patients remained in remission, whereas 7 patients showed relapse at varying intervals during the period of study. In 5 of these 7 patients the mean ACS exceeded 35% of the baseline clinical score, while 2 patients de­veloped flare up of new lesions at other sites. No major side effects were observed except for occurrence of pustular lesions at local sites in two patients.

Intermittent topical therapy with cortico­steroids helps to reduce the side effects and prevents tachyphylaxis. This study provides evidence of beneficial effects of topical pulse therapy with clobetasol propionate (0.05%) given at weekly intervals. Achievement of re­mission upto a period of 12 weeks in 66.6% patients of psoriasis correlates well with the findings of Katz et a1 [4], who observed 73.8% of patients to respond to betamethasone dipropionate (0.05%). Hradil et a1 [5], also re­ported success with intermittent use of clobetasol propionate by achieving remissions upto a period 21 weeks in 75% of cases, whereas van Dick et a1 [6], did not find any sig­nificant difference between continuous and intermittent therapy though the total dose of the corticosteroids required to control the dis­ease was much less with intermittent therapy.

 
  References Top

1.Stevanovic DV : Corticosteroid induced atrophy of the skin with telangiectasis, Brit J Dermatol, 1972; 87 : 548-566.  Back to cited text no. 1    
2.Keczkes K, Teasdale P, Wiseman RA et al : Plasma cortisol values after topical application of diflucortolone valerate (0.3%) and clobetasol pro­pionate (0.05%) in psoriatic patients, Brit J Dermatol, 1978; 99 : 417-420.  Back to cited text no. 2    
3.Duvivier A and Stoughton RB : Tachyphylaxis to the action of topically applied corticosteroids, Arch Dermatol, 1975; 111 : 581-583.  Back to cited text no. 3    
4.Kartz HI, Hien TN, Prawer SE et al : Betamethasone dipropionate in optimized vehicle; intermittent pulse dosing for extended maintenance treatment of psoriasis, Arch Dermatol, 1987; 123 : 1308-1311.  Back to cited text no. 4    
5.Hradil E, Lindstrom C and Moller, H : Intermittent treatment of psoriasis with clobetasol propionate, Acta Dermatol Venereal, 1978; 58 : 375-377.  Back to cited text no. 5    
6.Van Dijk E, Bakkers Ej, Ngo Mj et al : Intermittent topical treatment of psoriasis with betamethasone dipropionate 0.05% cream, cutis, 1983; 32 : 284­287.  Back to cited text no. 6    




 

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