Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0152030 (skin irritation)
 2,146 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

High-potency topical corticosteroids are very effective for the treatment of psoriasis, but are associated with a number of cutaneous adverse effects. Vitamin D modulators have emerged as an important alternative to corticosteroids for the long-term topical treatment of psoriasis. Calcitriol 3 microg/g ointment has long been used to treat psoriasis in Europe and is now the only vitamin D3 ointment available for use in the United States (U.S.). Several randomized clinical trials have compared the safety, efficacy, and cosmetic acceptability of calcitriol ointment with other topical psoriasis therapies. In a three-week investigator-blinded study of 25 healthy subjects, calcitriol 3microg/g ointment was associated with markedly less cumulative skin irritation than was calcipotriene ointment. A multicenter, investigator-blinded study of patients with psoriasis found that investigator-rated global improvement of psoriasis symptoms with calcitriol ointment was statistically noninferior to calcipotriene ointment and that calcitriol use produced significantly fewer patients with cutaneous reactions or discomfort. A multicenter clinical trial of patients with psoriasis who had lesions affecting sensitive skin areas found that calcitriol use produced less skin irritation than did calcipotriene and was generally preferred to calcipotriene ointment by patients. Calcitriol was also significantly more effective for the treatment of psoriasis lesions affecting flexural areas. In another study, patients who received calcitriol ointment exhibited improvement in psoriasis symptoms that was similar to the corticosteroid betamethasone propionate, but were much less likely to have relapsed eight weeks after treatment discontinuation. Two clinical studies also suggested that calcitriol is similar in efficacy to short-contact dithranol, but with a lower incidence of skin irritation and staining. Together, the results of these studies demonstrate that calcitriol 3 microg/g ointment is a significant new option for topical therapy of psoriasis. Calcitriol ointment produces improvement in psoriasis symptoms that is generally similar to the improvement attained with other (except for high potency steroid) topical psoriasis therapies, with a low incidence of adverse events.
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PMID:Calcitriol 3 microg/g ointment: an effective and safe addition to the armamentarium in topical psoriasis therapy. 1970 32

Topical corticosteroids and vitamin D analogs are well established as safe and effective first-line treatments for mild to moderate plaque psoriasis. They act via distinct and complementary mechanisms of action: vitamin D analogs primarily counter epidermal dysregulation, inhibiting epidermal hyperproliferation and inducing keratinocyte differentiation, whereas corticosteroids act primarily as immunosuppressors, targeting pro-inflammatory cytokines and chemokines. Furthermore, both agents have additional activity that may complement their main effects: vitamin D analogs have some immunomodulatory properties and corticosteroids may impact on keratinocyte differentiation. Based on their dominant mechanisms of action, there is a strong scientific rationale for the combination of corticosteroids and vitamin D analogs in the treatment of plaque psoriasis. Indeed, the combination has been shown to have a greater effect on the immune-mediated mechanisms of psoriasis than either monotherapy used alone. There is also a strong biological rationale for decreased side effects with the combination. Vitamin D may restore epidermal barrier function, which is impaired with corticosteroid use, and counteract steroid-induced skin atrophy. Corticosteroids may reduce perilesional skin irritation induced by vitamin D analogs. Although clinical data strongly support improved efficacy and tolerability with a combination of calcipotriol and betamethasone dipropionate, additional studies are needed to further investigate their underlying mechanisms.
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PMID:The biological rationale for use of vitamin d analogs in combination with corticosteroids for the topical treatment of plaque psoriasis. 2398 73