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Betamethasone is best treatment in intertriginous psoriasis

What is the best treatment for intertriginous psoriasis?

What is the best treatment for intertriginous psoriasis?

Synopsis

Intertriginous psoriasis occurs in the axillae, under the breasts, in the inguinal folds and on the buttocks and genitals. It is very pruritic and is typically worsened by perspiration.

Treatment options (all topical) include steroids, pimecrolimus and tacrolimus, and calcipotriol.

In this study, 80 patients from a dermatology clinic were randomly assigned to receive either 1% pimecrolimus, 0.005% calcipotriol, 0.1% betamethasone valerate, or vehicle cream once daily for four weeks, followed by six weeks without treatment.

The primary outcome was the Modified Psoriasis Area and Severity Index (M-PASI) measured at days 0, 14, 28, 42 and 70. Groups were balanced at the start of the study and analysis was by intention to treat.

There were only five withdrawals, including three in the betamethasone group. The mean M-PASI scores decreased from 22.1 to 2.9 in the betamethasone group (86%), from 25.3 to 9.7 in the calcipotriol group (62%), from 19.5 to 11.5 in the pimecrolimus group (39.7%), and from 18.2 to 13.8 in the placebo group (21.1%).

There were statistically significant differences between betamethasone and pimecrolimus, betamethasone and vehicle cream, and between calcipotriol and vehicle cream. There was no significant difference between pimecrolimus and vehicle cream.

The authors of this study, funded by the manufacturer of pimecrolimus, describe the adverse effects of betamethasone and calcipotriol but do not mention that adverse effects were actually most common in the pimecrolimus group.

It is important to note that the European Medicines Agency, which checks the safety of drugs in the European Union, has warned doctors and patients using pimecrolimus about a possible risk of skin cancer and lymphoma.

Level of evidence
1b (see www.infopoems.com/concept/eb,_ loe .cfm)

Study design
Randomised controlled trial (double-blinded).

Funding
Industry

Setting
Outpatient (specialty)

Allocation
Concealed

Reference
Kreuter A, Sommer A, Hyun J et al. 1% pimecrolimus, 0.005% calcipotriol and 0.1% betamethasone in the treatment of intertriginous psoriasis. A double-blind, randomised controlled study. Arch Dermatol 2006; 142:1138-1143.

Bottom Line: For intertriginous psoriasis, betamethasone is more effective than calcipotriol; calcipotriol is more effective than placebo; and pimecrolimus is minimally, if at all, effective.

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