Clobetasol-17-propionate lotion under hydrocolloid dressing (Duoderm ET) once weekly versus unoccluded clobetasol-17-propionate ointment twice daily in psoriasis: an immunohistochemical study on remission and relapse

It is: well established that the efficacy of corticosteroids under occlusio n with hydrocolloids (HCD) is superior compared to monotherapy with topical corticosteroids. However, following treatment with more potent corticoster oids, increased side effects and a more pronounced rebound might be expecte d. In the present clinical study, the efficacy of relapse after and the saf ety characteristics of two treatment modalities were compared: clobetasol-1 7-propionate lotion under an HCD dressing once weekly versus clobetasol-17- propionate ointment without an HCD twice daily. Clinical assessments were r ecorded and skin biopsies were taken before therapy, at clearance and 6 wee ks after clearance. A panel of monoclonal antibodies to characterize epider mal proliferation, differentiation and inflammation were selected. In addit ion, clinical and histological assessments for skin atrophy mere made. Both therapies had a major therapeutic effect, which was reflected in the clini cal and immunohistochemical parameters. The only difference between the two therapies was a faster remission induction time in patients treated with c orticosteroids combined with HCD, Six weeks after discontinuation of treatm ent, similar clinical and histological signs of relapse were observed for b oth therapies. Clinically, there were no signs of skin atrophy but histolog ically, epidermal thinning occurred to the same extent with both therapies but proved to be reversible within 6 weeks of discontinuation of treatment. From this study it can be concluded that the combination of HCD and cortic osteroids is able to induce relatively fast remission compared to corticost eroid monotherapy but relapse and safety characteristics are comparable to the unoccluded corticosteroid therapy.