Are topical corticosteroids useful in phototherapy for psoriasis?

doi:10.1016/S0190-9622(89)70085-2

Journal of the American Academy of Dermatology

Volume 20, Issue 5, Part 1, May 1989, Pages 748-754

https://doi.org/10.1016/S0190-9622(89)70085-2 Get rights and content

Abstract

A prospective, randomized, double-blind, placebo-controlled trial was performed to assess the effect of a potent topical corticosteroid cream used in conjunction with ultraviolet B (UVB) phototherapy on psoriasis with respect to time to clearing and duration of remission after clearing. Of the 53 outpatients who received suberythemogenic UVB phototherapy three times per week, 24 applied the topical corticosteroid and 29 applied the placebo cream twice daily until clearing was achieved. Nine patients in each group failed to comply with the protocol. Although there was a trend toward a slightly more rapid response in the topical cofticosteroid-treated group, there was no significant difference in patients' early response to therapy, number of treatments, and UVB dose required to achieve clearing. Patients in the topical corticosteroid-treated group remained in remission longer than did patients in the control group (183 vs 116 days). Life-table analysis predicts that 62% of emollient-treated patients flare within 6 months of clearing compared with only 42% of topical corticosteroid-treated patients (p<0.1). For most patients with psoriasis who receive UVB therapy in an outpatient setting, the use of potent topical corticosteroids appears to produce, at most, a modest beneficial effect.

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Due to the complex etiology of psoriasis, existing treatments for psoriasis are mainly based on symptom control. Mild or limited psoriasis is treated with topical corticosteroids [9] and/or vitamin D analogues [10]. Moderate to severe and/or extensive psoriasis may require phototherapy, and systemic agents such as oral retinoids [11], methotrexate [12,13], biological agents [14], cyclosporine [15–17] or apremilast [18].
The aryl hydrocarbon receptor (AhR), a ligand-dependent transcription factor, can regulate the immune balance of Th17/22 and Treg cells, which plays an important role in the development and maintenance of the skin barrier. We herein report the discovery of triazolopyridine derivatives as a new class of AhR agonists. Structure-activity relationship analyses led to the identification of the most active compound, 6-bromo-2-(4-bromophenyl)-[1,2,4]triazolo[1,5-a]pyridine (12a), with an EC₅₀ (50% effective concentration) value of 0.03 nM. Compound 12a could induce rapid nuclear enrichment of AhR, trigger the transcription of downstream genes and promote skin barrier repair. Topical or oral administration of 12a could significantly alleviate imiquimod (IMQ)-induced psoriasis-like skin lesion. Considering the excellent in vivo anti-psoriasis activity as well as good pharmacokinetic properties, 12a could be a promising lead compound for drug discovery against psoriasis, and deserving further investigation.
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Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 3.2% of the world's population. In this section of the guidelines of care for psoriasis, we will focus the discussion on ultraviolet (UV) light–based therapies, which include narrowband and broadband UVB, UVA in conjunction with photosensitizing agents, targeted UVB treatments such as with an excimer laser, and several other modalities and variations of these core phototherapies, including newer applications of pulsed dye lasers, intense pulse light, and light-emitting electrodes. We will provide an in-depth, evidence-based discussion of efficacy and safety for each treatment modality and provide recommendations and guidance for the use of these therapies alone or in conjunction with other topical and/or systemic psoriasis treatments.
Phototherapy: Kids are not just little people
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Citation Excerpt :
Although topical corticosteroids are often used in conjunction with UVB therapy in psoriasis, there are few reliable studies documenting superior outcomes in patients treated with combination therapy compared with phototherapy alone. A prospective, randomized, double blind, placebo-controlled trial compared UVB plus potent topical corticosteroids to UVB plus placebo cream in 53 adult patients with psoriasis.27 Although there was a non-significant trend towards more rapid clearance in the corticosteroid treated group, the 2 groups had nearly identical rates of clearance with no difference in the number of treatments needed to achieve clearance.
Phototherapy is the delivery of treatments in the form of visible or ultraviolet light for the therapeutic care of a patient. Usage of phototherapy in children is affected by limited data in the medical literature, the inability of some children to stand still during the delivery of therapy, parental concerns regarding risks of therapy, and scheduling difficulties. Despite the limitation of data, there are publications in support of usage of phototherapy, especially for psoriasis, atopic dermatitis, and vitiligo in both children and adults. This contribution provides an overview of the utility of phototherapy in skin conditions with a specific focus on the differences that exist in the data on and the delivery of phototherapy for adults and children.
Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy
2010, Journal of the American Academy of Dermatology
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Early trials demonstrated a more rapid clearing of psoriasis when UVB was used in conjunction with topical fluocinolone or clobetasol propionate (used in combination with UVB and topical anthralin).55 However, other studies failed to demonstrate a benefit in either the clearance or the remission rate, and some studies suggest that the use of topical corticosteroids in conjunction with UV therapy may be associated with a higher relapse rate.56-58 Thus, it is unclear whether the use of topical steroids in combination with UVB is beneficial.59
Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this fifth of 6 sections of the guidelines of care for psoriasis, we discuss the use of ultraviolet (UV) light therapy for the treatment of patients with psoriasis. Treatment should be tailored to meet individual patients' needs. We will discuss in detail the efficacy and safety as well as offer recommendations for the use of phototherapy, including narrowband and broadband UVB and photochemotherapy using psoralen plus UVA, alone and in combination with topical and systemic agents. We will also discuss the available data for the use of the excimer laser in the targeted treatment of psoriasis. Finally, where available, we will summarize the available data that compare the safety and efficacy of the different forms of UV light therapy.
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View all citing articles on Scopus

^**: From the Department of Dermatology and the Charles A. Dana Research Laboratories, Beth Israel Hospital and Massachusetts General Hospital, Harvard Medical School.

^*: Recipient of a McLaughlin Research Fellowship from Canada during this study.

View full text

Are topical corticosteroids useful in phototherapy for psoriasis?

Abstract

J Am Acad Dermatol

Derm Clin

J Am Acad Dermatol

J Invest Dermatol

The treatment of psoriasis

Northwest Med

Fluocinolone—plastic treatment and traditional treatment in severe psoriasis: comparative study

Acta Derm Venereol (Stockh)

Studies on the pathogenesis of acute inflammation II. The action of cortisone on the inflammatory response to thermal injury

J Exp Med

The effect of corticosteroids on human epidermal mitotic activity

Arch Dermatol

Tachyphylaxis to the action of topically applied corticosteroids

Arch Dermatol