Scalp psoriasis: topical calcipotriol 50 micrograms/g/ml solution vs. betamethasone valerate 1% lotion.

Forty-two patients aged between 6 and 61 years (mean: 33.5 years) with psoriasis of the scalp were enrolled in this study. Twenty-seven patients (69%) were males and 15 (31%) were females. The aim of our study was to evaluate the efficacy, safety and tolerability of topical calcipotriol 50 micrograms/g/ml solution vs. betamethasone valerate 1% lotion in the treatment of psoriasis of the scalp. The study was randomized with the twice-daily application of either calcipotriol solution or betamethasone valerate lotion for 6 weeks. Treatment evaluation was clinically based on signs of psoriasis (thickness, redness, scaliness) which were scored from 0 = absent to 4 = severest possible involvement and was performed at the start of treatment and at weeks 2 and 6 of treatment. The results showed a marked improvement and clearance at the end of treatment in 15 (72.8%) of the 24 patients in the calcipotriol group and in 13 of the 18 patients (72%) in the betamethasone group. The mean total sign score at baseline was 5.1 in the calcipotriol group and 5.4 in the betamethasone valerate group. At the end of treatment, this score was decreased to 2.1 and 1.49, respectively. No significant adverse effects were reported in either group except in two patients (8.3%) in the calcipotriol group who developed signs of irritation including itching and erythema. In conclusion, both drugs were effective and well tolerated in the treatment of scalp psoriasis but in some patients calcipotriol had to be given for more prolonged courses.

Calcipotriol in the treatment of childhood vitiligo.

Eighteen patients with a clinical diagnosis of vitiligo, aged between three and 12 years (mean 8.9 years), were enrolled in this study in order to evaluate the efficacy and tolerability of topical calcipotriol in the treatment of childhood vitiligo. Six patients (33.3%) were males and 12 were females (66.7%). Fourteen patients (77.8%) had focal vitiligo, two (11.1%) had mucosal vitiligo and two (11.1%) had segmental vitiligo. The face was involved in 11 patients (61.1%). The treatment was applied twice daily as 50 microg/gm cream in nine patients and as ointment in the remaining patients. Treatment assessment was carried out clinically at 2 weeks, and then monthly for 4-6 months. Four patients (28.6%) were excluded from the study (one due to irritation and three due to lost contact in follow-up). Fourteen patients (71.4%) completed the treatment course (> 3 months). Of the treated patients, ten (77.8%) showed improvement and four patients (22.2%) had no response. Among responders, three patients (21.4%) showed complete resolution, four (28.6%) showed 50%-80% improvement and three patients (21.4%) showed 30% to < 50% improvement. Only one patient (5.5%) developed irritation. In conclusion, calcipotriol is an effective treatment in vitiligo. Better results are obtained with ointment than with cream. Calcipotriol can be helpful in children in whom potent steroids and PUVA are not advisable.

Calcipotriol cream in the treatment of flexural psoriasis.

In patients with psoriasis, 2-6% suffer from flexural psoriasis. Areas where flexural psoriasis is found are the axillae, groin, submammary region, perianal region, and retroauricular fold. Eleven patients with flexural psoriasis were enrolled in this study: six men and five women, aged between 5 and 55 years. All patients had common psoriasis presented with psoriatic lesions involving the axillae, groin and submammary region. Each patient was instructed to apply calcipotriol 50 microg/gm twice daily for 6 weeks. The treatment assessment, based on changes in erythema, scaling and thickness scores, was carried out at 2, 4 and 6 weeks. The overall assessment of our cases in this study showed a marked and significant improvement in the treated intertriginous areas. The mean scores of erythema, scaling and thickness before treatment were 2.7, 2.3 and 2.5, respectively. There was a marked and dramatic improvement in seven patients (63.6%) within the first 2 weeks in which the response was more significant than other nonintertriginous psoriatic lesions. At the end of treatment, 10 patients (91%) showed complete clearance, and the mean scores were reduced to 0. One patient showed only moderate improvement. No significant adverse effect was reported. In conclusion, calcipotriol cream is effective, safe and well tolerated in the treatment of flexural psoriasis. Because tar preparations and anthralin are irritants and potent steroids are absorbed more in these areas, calcipotriol cream could be a better choice for the treatment of these cases.

Occlusive versus nonocclusive calcipotriol ointment treatment for palmoplantar psoriasis.

Thirty-nine patients with a clinical diagnosis of palmoplantar psoriasis [23 (58%) males and 16 (42%) females] were included in this study with the aim of evaluating the efficacy of occlusive calcipotriol 50 micrograms/mg ointment vs. nonocclusive therapy. Patients were randomized to either twice-weekly overnight calcipotriol ointment under occlusion or twice-daily topical nonocclusive application of the same ointment for 6 weeks. The effect of treatment was assessed on the basis of a psoriasis signs score for erythema, thickness and scaliness, which was graded from 0 (absent) to 4 (most severe) at the first visit, after 2 weeks and at the end of treatment. Analysis of our results showed that twice-weekly occlusive calcipotriol ointment was as effective as the twice-daily application. The mean total score at baseline was 6 for the occlusive group and 6.1 for the nonocclusive group. The score decreased to 1.5 in both groups at the end of treatment. No significant adverse effects were reported by patients or investigators. We conclude that occlusive calcipotriol ointment is effective in the treatment of palmoplantar psoriasis and may produce even better results with more frequent use, such as application on alternate days.

Tinea capitis in Benghazi, Libya.

BACKGROUND: Tinea capitis is a worldwide problem. It affects mainly school age children. Late detection and improper treatment of the inflammatory type of this disease may result in disfigurement and permanent alopecia. The objectives of this study were to determine the prevalence, clinical types, and causative species of tinea capitis in Benghazi, Libya. METHODS: One hundred and ninety six patients with tinea capitis were enrolled in this study. Hair stumps and scales were collected from every case and exposed to direct microscopic examination using 10% potassium hydroxide solution, and cultivation on modified Sabouraud's dextrose agar with cyclohexamide and chloramphenicol. RESULTS: Tinea capitis accounts for 45% of all superficial fungal infection and 92% occurred in children below the age of 10 years. The gray patch type was the most common clinical variety (53.6%), followed by black dots, seborrhoid type, and kerion (25.5%, 10.2%, and 8.2%), respectively. Four patients with a clinical picture of alopecia areata-like lesion and one patient with a favus-type lesion were seen. Species identification revealed that Trichophyton violaceum was the most common causative agent, responsible for 49.4% of infection, followed by Microsporum canis (38.6%) and T. verrucosum (7.8%). From seven patients the isolate was a mixture of both T. violaceum and M. canis. CONCLUSIONS: There has been a dramatic decrease in the incidence of favus with complete disappearance of T. schoenleinii. T. verrucosum as a causative agent of tinea capitis in this area has been reported for the first time in this study.