INPATIENT TREATMENT WITH CALCIPOTRIOL VERSUS DITHRANOL IN REFRACTORY PSORIASIS

Calcipotriol (50 mu g/g) ointment recently became available for the tr eatment of psoriasis. Calcipotriol has been shown to be superior to ho me treatment with dithranol. The time-honoured regime of in-patient to pical treatment with dithranol in paste or petrolatum for 24 hours is the gold standard of optimal efficacy of antipsoriatic therapy. This t reatment regime is adopted in case of insufficient control of psoriasi s by out-patient treatments. The aim of the present study was to chall enge the position of in-patient dithranol treatment. A left-right comp arative case-control study was designed in ten patients hospitalised w ith refractory psoriasis, comparing classical dithranol treatment and calcipotriol treatment. In contrast to what wets expected six of the t en patients showed a more pronounced improvement after two weeks at th e calcipotriol treated sides. irritation from calcipotriol was observe d in four patients after one week and in two patients after two weeks treatment. At the dithranol treated sides three of the ten patients sh owed a better improvement. Four patients experienced irritation after one week and eight patients after two weeks. Irritation due to calcipo triol was not associated with an increased irritation due to dithranol , which implies that both treatments have a different mechanism of irr itation. The present case-control study indicates that calcipotriol ha s challenged the untouchable superiority of classical in-patient treat ment with dithranol. Further studies are indicated to improve complian ce in out-patient calcipotriol treatment with cream formulations and o nce a day schedules.