CALCIPOTRIOL OINTMENT IN NAIL PSORIASIS - A CONTROLLED DOUBLE-BLIND COMPARISON WITH BETAMETHASONE DIPROPIONATE AND SALICYLIC-ACID

This double-blind randomized study was designed to compare the efficac y and safety of calcipotriol ointment (50 mu g/g) with betamethasone d ipropionate (64 mg/g) and salicylic acid (0.03 g/g) ointment in the tr eatment of nail bed psoriasis. Fifty-eight patients applied the given drug to the affected nails twice a day for 3-5 months, depending on cl inical response. Efficacy was assessed monthly on the basis of nail th ickness, measured in millimetres. Photographs of the treated nails wer e taken at baseline, and after 3 and 5 months. Tolerability was assess ed at 3 and 5 months. In patients with fingernail psoriasis, after 3 m onths of treatment subungual hyperkeratosis was reduced from 2.3 +/- 0 .1 mm (mean +/- SEM) to 1.5 +/- 0.1 mm (-26.5%) in the calcipotriol gr oup and from 2.3 +/- 0.1 mm to 1.6 +/- 0.1 mm (-30.4%) in the betameth asone dipropionate and salicylic acid group [not significant (NS) betw een treatments, analysis of variance (ANOVA)]. After 5 months, respond ers showed a 49.2% reduction in hyperkeratosis in the calcipotriol gro up(from 2.8 +/- 0.1 mm to 1.4 +/- 0.2 mm) and 51.7% (from 2.1 +/- 0.1 mm to 1.0 +/- 0.1 mm) in the betamethasone dipropionate and salicylic acid group (P < 0.001 from baseline, NS between treatments, ANOVA). In patients with toenail psoriasis, after 3 months of treatment there wa s an overall reduction in hyperkeratosis from 2.6 +/- 0.1 mm to 2.1 +/ - 0.1 mm (-20.1%) in the calcipotriol group and from 3.0 +/- 0.1 mm to 2.3 +/- 0.1 mm (-22.9%) in the betamethasone dipropionate and salicyl ic acid group (P < 0.001 from baseline, NS between treatments, ANOVA). By the end of the fifth month there was a 40.7% reduction in hyperker atosis in the calcipotriol group (from 2.1 +/- 0.1 mm to 1.2 +/- 0.1 m m) and 51.9% in the betamethasone dipropionate and salicylic acid grou p (from 2.7 +/- 0.1 mm to 1.3 +/- 0.1 mm; P < 0.0001 from baseline, NS between treatments, ANOVA). The results of the study show that calcip otriol is as effective as a combination of a topical steroid with sali cylic acid in the treatment of nail psoriasis and represents a safe al ternative in the topical treatment of nail psoriasis.