EVALUATION OF TOPICAL DRUG-TREATMENT IN PSORIASIS

Background: During the last decade important innovations in the topica l treatment of psoriasis have been accomplished, and important investm ents in new drug development for psoriasis are planned. Methods: A sur vey was conducted among psoriatic patients in order to quantify the pr esent mode of use of topical drugs by the patients, the mode of prescr iption by their doctors and the compatibility of actual use and instru ctions to the patients. Results: Major observations are: The distribut ion of lesions, in particular on the scalp and soles, justifies major investments in the development of a treatment at these locations. Calc ipotriol and topical corticosteroids (classes III and TV) are by far t he most frequently prescribed topical drugs. Although at the time of i nvestigation, calciopotriol was only available as ointment in the Neth erlands, it is prescribed twice as often as clobetasol which is both a vailable as an ointment and cream. Dermatologists are responsible for approximately 2/3 and general practitioners for 1/3 of the prescriptio ns. The prescription by general practitioners also comprises the conti nuation of prescriptions by the dermatologist. The duration of topical treatment is unrestricted in the majority of patients. However, use o f up to 8 weeks is only seldom practised. Therefore, long-term safety and efficacy data of these drugs are mandatory for any topical treatme nt. Although twice daily treatment was advised in 50% of all patients, this treatment frequency was followed in only 33% of them. Greasiness accounted for non-compliance in 11% of the patients. Less frequent ap plications were desired by 38% of the patients, including patients on a once-a-day regimen. Most patients preferred the cream formulation. H owever, the variability of the expression of psoriasis (dry cracked ex udative or superficially scaling lesions) required the availability of both cream and ointment formulations. Conclusion: An optimal treatmen t of psoriasis requires a spectrum of topical drugs and their formulat ions in different vehicles.