Steroids, Steroid/Vitamin D Combo Best Bets for Scalp Psoriasis

Steroids and the two-compound combination of a steroid plus vitamin D are the most effective treatments for scalp psoriasis, according to a new Cochrane review.

Statistically, the combination product was more effective than the steroid alone, but clinically the benefit was questionable. “Given the similar safety profile and only slim benefit of the two-compound combination over the steroid alone, monotherapy with generic topical steroids may be fully acceptable for short-term therapy,” the review authors conclude. The most common side effects of these treatments were irritation, itching and skin pain at the site of application.

The new review included 59 randomized controlled trials with a total of 11,561 participants. Thirty studies were either conducted or sponsored by the manufacturer of the study medication.  Most findings were limited to short-term treatments, since most studies were conducted for less than six months. Only one trial investigated long-term therapy (12 months). Most studies did not measure improvement in quality of life.

The authors graded the quality of evidence to three major comparisons: steroid versus vitamin D, two-compound combination of steroid and vitamin D versus steroid monotherapy and versus vitamin D. There was not enough evidence to assess the efficacy and safety of other topical treatments, such as salicylic acid, tar or dithranol.

Going forward, long-term studies as well as those that assess quality of life are warranted, the review authors note. Other questions that remain include “Is there truly no difference in terms of effectiveness or safety between topical corticosteroids of different strength? Does the vehicle preparation have any influence on how the active agent works? Which topical treatment leads to disease control over a long time span without risking patient's safety?”