Advances in topical treatments for psoriasis have kept pace with a rapidly evolving comprehension of its pathogenesis, making a review of current therapies useful for those who treat psoriasis. Recent randomized controlled trials comparing coal tar and calcipotriol have shown comparable clinical efficacy (calcipotriol has a faster onset of action) and similar relapse rates (level I evidence). Since this might be of concern with respect to systemic toxicity, some authors suggest combining salicylic acid with a mid-potency steroid. Molecular mechanisms of tazarotene action in psoriasis. However, in clinical practice, complicating the treatment regimen with more than one topical product may reduce the likelihood of consistent adherence to the treatment regimen. Other topical therapies used for psoriasis (eg, tazarotene, coal tar shampoo, anthralin) and intralesional corticosteroid injections also may be beneficial for scalp involvement, though data on efficacy specifically in scalp disease are limited 10. The mechanism of action of corticosteroids in psoriasis is not fully understood. Absorption of tazarotene was minimal over the 12-week course of the study, suggesting that systemic toxicity is unlikely during long-term therapy. Most psoriasis patients are treated with topicals.
Received grants for clinical research from: Abbott Laboratories; Amgen Inc.; Other innovative treatments are undergoing clinical studies, with the aim of maintaining safe, long-term control of the condition. The combined medical therapy with different mechanisms of action and safety profiles enhances efficacy.
Application of coal tar once daily followed by UV therapy (Goeckerman treatment) remains an effective modality. Emphasis on combination, rotational, and sequential therapies has increased because of the numerous mechanisms of action, vehicles of delivery, and side effects of psoriasis medications. 51 Headaches, nonspecific infections, fevers, chills, nausea, and pain are the most common adverse effects.52 No statistically significant increase in infections, cumulative toxicity, or end-organ damage has been documented. Stein L. Clinical studies of a new vehicle formulation for topical corticosteroids in the treatment of psoriasis. The aim of this study was to ascertain the effects of a Homoeopathic complex remedy on psoriasis. 4 Tools used to assess psoriasis in clinical practice and clinical trials 9 2.4.1 Psoriasis Area and Severity Index (PASI) 9. Furthermore, management and treatment of psoriasis and previous research of the condition show us the following limitations: many of the current treatment modalities are expensive, there is limited information about the long term side effects/ consequences of some of the newer biological therapies, and many of the treatment regimens include medication of a toxic nature with potentially serious side effects. The exact mechanism of action of both coal tar and anthralin remains unknown, though it is suspected to inhibit epidermal proliferation (Witman, 2001). Combined Exposure to Asphalt and Coal Tar Pitch 140 a.
Psoriasis is a common dermatologic condition manifested by plaque formation, which can be both difficult and expensive to treat. The Psoriasis Area and Severity Index (PASI) scoring system is commonly used to assess the severity of psoriasis in clinical trials.2 The PASI is a numeric scoring system ranging from 0 (no disease) to 72 (severe psoriasis) that accounts for both disease severity and percent of body surface area (BSA) affected. Although used less frequently, other topical agents include salicylic acid, moisturizers, anthralin, and coal tar. The biologic agents can be categorized by their mechanism of action, as either T-cell modulators or cytokine modulators. Indications and mode of administration of commercially available retinoids in dermatological therapy. Here, the check points in the metabolic pathway of retinoids whereby xenobiotics can influence these agents are of major interest with regard to clinical retinoid therapy. Accordingly, retinoid-induced inhibition of basal as well as coal tar- and glucocorticoid-induced CYP1A1 expression in human skin, as reported byLi et al. There is an unmet need for less toxic and more effective psoriasis treatments that produce long-lasting remissions. As expected and predicted from the mechanism of action of alefacept, these clinical improvements were related to selective reductions in memory T cells. Use of moderate-potency topical corticosteroids, topical retinoids, coal tar, keratolytics, and vitamin D analogues was prohibited within 2 weeks of study drug administration and throughout the study, except on the scalp, palms, groin, anal fold, and soles.