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Steroids as good as vitamin D for psoriasis

By Lilian Anekwe

Steroids perform as well as vitamin D analogues for topical treatment of chronic plaque psoriasis, UK researchers conclude in a new gold-standard review.

The Cochrane review, which analysed data on more than 21,000 patients, found topical steroids were as effective and as well tolerated as vitamin D analogues, while the two treatments in combination performed best of all.

The review of 131 randomised controlled trials lasting between one and 24 weeks found vitamin D, and all but one of the steroids included in the analysis, were significantly more effective than placebo.

Relative to vitamin D, combined treatment with vitamin D and steroid was more effective, achieving a 0.48 point improvement on a 6-point assessment scale.

The combined regimen was also more effective than steroids alone, offering an improvement of 0.55 points.

Stronger steroids including betamethasone diproprionate and the more potent clobetasol propionate were also effective, though potent steroids were also more likely to cause local adverse events and skin irritation.

There was no difference between any of the treatments and placebo in systemic adverse events.

Anne Mason, a research fellow at the centre for health economics at the University of York concluded: ‘Evidence from large numbers of trials indicates that most of the topical treatments tested in the trials reviewed here alleviate the symptoms of psoriasis.

‘Steroids perform as well as vitamin D analogues and are associated with a lower incidence of local adverse events. Combined treatment of vitamin D with steroid is more effective than either vitamin D alone or steroid alone.'

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