A Comparison Of Three Therapeutic Modalities In Scalp Psoriasis And A Review Of Literature

Abstract

Despite the development of newer patient- friendly agents and regimens, treatment of scalp psoriasis is difficult and relapse are common. The adverse effects and drawbacks of topical corticosteroids and calcipotriol led us to compare the effects of three relatively bland therapeutic agents in a prospective randomized trial in scalp psoriasis. A literature search was also done on the treatment of scalp psoriasis. Forty patients with scalp psoriasis were randomized to receive any of the following topical therapies under overnight occlusion:5% coal tar solution mixed 1:1 in coconut oil; a preparation containing 10% urea, 10% lactic acid, 10% propylene glycol and 10% liquid paraffin in a washable cream base and only coconut oil. The 3 groups showed significant improvement in 57%, 64.4% and 58.3% patients respectively (p<0.1). Clearance rates were also comparable between the groups. There were no adverse effects reported in patients using tar or coconut oil. The literature search revealed that only topical corticosteroids had substantially higher response and clearance rates that those achieved by us. The risk/ benefit ratios of topical corticosteroids and calcipotriol vs bland emollients and their place in the treatment of scalp psoriasis are discussed.