Ardelean, Gavril - Buicu, Florin (szerk.): Satu Mare. Studii şi comunicări. Seria ştiinţele naturale 7. (2006)
Medicină
Satu Mare - Studii şi Comunicări Seria Ştiinţele Naturii\!o\. VII (2006) Tabelul 1. Advantages and Disadvantages of Topical Agents for the Treatment of Psoriasis TOPICAL THERAPY ADVANTAGE DISADVANTAGE Topical corticosteroids Very effective Tachyphylaxis, possible adrenal suppression, skin atrophy Calcipotriene Effective Not for widespread disease, irritating on intertriginous areas and face, expensive Corticosteroid and calcipotriene Very effective, allows for rotation therapy minimizing corticosteroids side effects Not for widespread disease, expensive Tazarotene Effective Irritating, expensive Salicylic acid Keratolic, increases penetration of other agents Inactivates calcipotriol, blocks UV-B Coal tar Effective, no tachyphylaxis Messy, smelly Anthralin Effective Stains things it contacts, irritating T opical Corticosteroids The mainstay of topical therapy is topical corticosteroids, which locally suppress the immune system. PI Topical corticosteroids are available in different strengths measured by their vasoconstrictive effect. Class 1 steroids are 1000- 1500 times stronger than class VTI steroids. Topical corticosteroids of classes I, II, and III are referred to as fluorinated steroids because they usually have fluorine groups added to their structure that increase their strength and penetration. Common unwanted effects associated with corticosteroids include skin atrophy, striae, masking of local infections, hypopigmentation, telangiectasias, and tachyphylaxis (a loss of affect). Corticosteroids, in particular superpotent ones, can induce temporary reversible suppression of the hypothalamicpituitary-adrenal axis, particularly in children. High-potency corticosteroids should not be used in intertriginous areas because they can quickly cause skin atrophy, striae, and even ulceration. Weaker corticosteroids should be used on the face and intertriginous areas. The vehicle for topical agents affects their utility, with ointments being optimal for the trunk and extremities, and gels and mousses best for the scalp. Calcipotriene Calcipotriene is a synthetic vitamin D analog that is an effective first-or second-line treatment! Class I corticosteroids are more immediately efficacious. A combination regimen of calcipotriene and corticosteroids is superior to either one used exclusively. Long-term maintenance using halobetasol ointment twice daily on weekends and calcipotriene twice daily on weekdays was superior to weekend therapy with halobetasol and placebo during the week. Calcipotriene's most common side effect is irritation, most commonly on the face and intertriginous areas. Hypercalcemia is a very rare side effect. Tazarotene Tazarotene is a topical retinoid that effects a normalization of abnormal keratinocyte differentiation, a reduction in keratinocyte proliferation, and a reduction in inflammation in psoriasis.Flits major side effect is local skin irritation including pruritus, burning, and erythema occurring in a dose-related manner in up to 25% of patients. Concomitant use of mometasone furoate 0.1% cream (class IV) or fluocinonide 0.05% cream (class II) with tazarotene 0.1% gel applied once daily enhanced efficacy and diminished local cutaneous irritation. Salicylic Acid Emollients are an inexpensive, safe, and active but weak treatment for psoriasis. They work by hydrating and softening plaques' scaly, hyperkeratotic surfaces. In particular, emollients containing keratolytic agents such as salicylic acid can be useful for converting scaly, rough, or fissured plaques to smoother, pink plaques.[Ointments containing 2%-10% salicylic acid are often used in conjunction with topical medications to improve penetration. It is important to recall that aspirin or acetyl-salicylic acid is a wholly different compound from salicylic acid and wholly lacks keratolytic affect. 112
