Abstract
Background:
Topical corticosteroids have long been the cornerstone in thetreatment of steroid-responsive dermatoses. Despite the effectiveness of these formulations, there is a misperception that drugs delivered via ointments are more potent than those delivered via other vehicles. Potency, however, is a complex function of the physical and chemical properties of both the active ingredient and its vehicle. Studies have determined that newer vehicles (eg, lotions), particularly those in the super-high-potency class, not only heighten the ability of the active ingredient to penetrate skin but also are preferred by patients over ointments and creams.
Objective:
This review of the literature investigates the effectiveness andtolerability of a high-potency corticosteroid lotion compared with cream or emollient cream formulations in treating moderate to severe plaque-type psoriasis and atopic dermatitis.
Methods:
A literature search was conducted of US and international published clinical trials (1975 to November 2004) comparing all potencies of topical corticosteroid cream and lotion formulations using MEDLINE and the Web sites of individual dermatologic journals. No specific study designs were excluded from this search. Search terms included corticosteroid-responsive dermatoses, creams versus lotions, topical corticosteroid clinical trials, plaque-type psoriasis, atopic dermatitis, clobetasol propionate, drug bioavailability, Class I topical agents, and vasoconstriction. The primary diagnoses were moderate to severe plaque-type psoriasis and atopic dermatitis. Two unpublished clinical investigations comparing clobetasol propionate lotion 0.05% with clobetasol propionate cream 0.05% and emollient cream 0.05% in a total of 421 patients were also included.
Results:
In the 20 published and 2 unpublished trials identified and reviewed, the response rates were comparable between the lotion and cream formulations. In addition, in a psoriasis study, clobetasol lotion received significantly better cosmetic-acceptability ratings compared with clobetasol cream (P < 0.05).
Conclusion:
In the studies reviewed, the effectiveness and tolerability of clobetasollotion were comparable to those of clobetasol cream and emollient cream in studies in adults with moderate to severe psoriasis or atopic dermatitis
Key words: topical corticosteroids, potency, vehicle, vasoconstriction, anti-inflammatory, clobetasol propionate, Class I agents, plaque-type psoriasis, atopic dermatitis, efficacy, safety, duration of response, cosmetic acceptability
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References
- 1.Strober B.E., Washenik K., Shupack J.L. Principles of topical therapy. In: Freedburg I.M., Eisen A.Z., Wolff K., editors. 6th ed. vol 2. McGraw-Hill; New York: 2003. pp. 2319–2323. (Fitzpatrick's Dermatology in General Medicine). [Google Scholar]
- 2.Stoughton R.B. Percutaneous absorption of drugs. Annu Rev Pharmacol Toxicol. 1989;29:55–69. doi: 10.1146/annurev.pa.29.040189.000415. [DOI] [PubMed] [Google Scholar]
- 3.Valencia I.C., Kerdel F.A. Topical glucocorticoids. In: Freedburg I.M., Eisen A.Z., Wolff K., editors. 6th ed. vol 2. McGraw-Hill; New York: 2003. pp. 2324–2328. (Fitzpatrick's Dermatology in General Medicine). [Google Scholar]
- 4.Piacquadio D.J. Topical corticosteroids in clinical practice: Focus on fluticasone propionate. Cutis. 1996;57(Suppl 2):4–9. [PubMed] [Google Scholar]
- 5.Stoughton R.B., Wullich K. Relation of application time to bioactivity of a potent topical glucocorticoid formulation. J Am Acad Dermatol. 1990;22:1038–1041. doi: 10.1016/0190-9622(90)70148-b. [DOI] [PubMed] [Google Scholar]
- 6.Stoughton R.B. The vasoconstrictor assay in bioequivalence testing: Practical concerns and recent developments. Int J Dermatol. 1992;31(Suppl 1):26–28. doi: 10.1111/j.1365-4362.1992.tb04009.x. [DOI] [PubMed] [Google Scholar]
- 7.Galderma Laboratories . Galderma Laboratories, LP; Fort Worth, Tex: 1997. LP. Study no. CG.03.SPR.4637. Unpublished. [Google Scholar]
- 8.Decroix J., Pres H., Tsankov N. Clobetasol propionate lotion in the treatment of moderate to severe plaque-type psoriasis. Cutis. 2004;74:201–206. [PubMed] [Google Scholar]
- 9.Duweb G.A., Abuzariba O., Rahim M. Scalp psoriasis: Topical calcipotriol 50 micrograms/g/mL solution vs. betamethasone valerate 1% lotion. Int J Clin Pharmacol Res. 2000;20:65–68. [PubMed] [Google Scholar]
- 10.James M. A randomized, double-blind, multicenter trial comparing fluticasone propionate cream, 0.05%, and hydrocortisone-17-butyrate cream, 0.1%, applied twice daily for 4 weeks in the treatment of psoriasis. Cutis. 2001;67(Suppl 4):2–9. [PubMed] [Google Scholar]
- 11.Lassus A. Clinical comparison of alclometasone dipropionate cream 0.05% with hydrocortisone butyrate cream 0.1% in the treatment of atopic dermatitis in children. J Int Med Res. 1983;11:315–319. doi: 10.1177/030006058301100512. [DOI] [PubMed] [Google Scholar]
- 12.Lassus A. Alclometasone dipropionate cream 0.05% versus clobetasone butyrate cream 0.05%. A controlled clinical comparison in the treatment of atopicdermatitis in children. Int J Dermatol. 1984;23:565–566. doi: 10.1111/j.1365-4362.1984.tb04214.x. [DOI] [PubMed] [Google Scholar]
- 13.Molin L., Cutler T.P., Helander I., for the Calcipotriol Study Group Comparative efficacy of calcipotriol (MC903) cream and betamethasone 17-valerate cream in the treatment of chronic plaque psoriasis. A randomized, double-blind, parallel group multicentre study. Br J Dermatol. 1997;136:89–93. [PubMed] [Google Scholar]
- 14.Yawalkar S.J., Schwerzmann L. Double-blind, comparative clinical trials with halobetasol propionate cream in patients with atopic dermatitis. J Am Acad Dermatol. 1991;25:1163–1166. doi: 10.1016/0190-9622(91)70318-v. [DOI] [PubMed] [Google Scholar]
- 15.Bjornberg A., Hellgren L. Double-blind double-bind. Curr Med Res Opin. 1975;3:36–38. doi: 10.1185/03007997509113643. [DOI] [PubMed] [Google Scholar]
- 16.Kanof N.B., Blau S. Psoriasis: Treatment with a new topical corticosteroid. Cutis. 1976;17:796–798. [PubMed] [Google Scholar]
- 17.Bleehen S.S., Chu A.C., Hamann I. Fluticasone propionate 0.05% cream in the treatment of atopic eczema: A multicentre study comparing once-daily treatment and once-daily vehiclecream application versus twice-daily treatment. Br J Dermatol. 1995;133:592–597. doi: 10.1111/j.1365-2133.1995.tb02711.x. [DOI] [PubMed] [Google Scholar]
- 18.van Dijk E., Bakkers E.J., Go M.J. Intermittent topical treatment of psoriasis with betamethasone dipropionate 0.05 percent cream. Cutis. 1983;32:284–285. [PubMed] [Google Scholar]; van Dijk E., Bakkers E.J., Go M.J. Intermittent topical treatment of psoriasis with betamethasone dipropionate 0.05 percent cream. Cutis. 1983;32:287. [PubMed] [Google Scholar]
- 19.Parish L.C., Witkowski J.A. A comparison of betamethasone benzoate gel and betamethasone valerate cream. Cutis. 1976;17:972. [PubMed] [Google Scholar]; Parish L.C., Witkowski J.A. A comparison of betamethasone benzoate gel and betamethasone valerate cream. Cutis. 1976;17:984. [PubMed] [Google Scholar]
- 20.Svartholm H., Larsson L., Frederiksen B. Intermittent topical treatment of psoriasis with clobetasol propionate (“Dermovate”) Curr Med Res Opin. 1982;8:154–157. doi: 10.1185/03007998209112377. [DOI] [PubMed] [Google Scholar]
- 21.Pirozzi D.J. Evaluation of a new halcinonide formulation in the treatment of common dermatoses. Cutis. 1982;30:262–266. [PubMed] [Google Scholar]
- 22.Afzelius H.W., Jacobsen K.U. A double-blind controlled trial of betamethasone dipropionate 0.05% (Diproderm) in comparison with fluocinolone acetonide 0.025% (Synalar) inpsoriasis and other steroid-responsive dermatoses. J Int Med Res. 1979;7:411–414. doi: 10.1177/030006057900700514. [DOI] [PubMed] [Google Scholar]
- 23.Viglioglia P., Jones M.L., Peets E.A. Once-daily 0.1% mometasone furoate cream versus twice-daily 0.1% betamethasone valerate cream in the treatment of a variety of dermatoses. J Int Med Res. 1990;18:460–467. doi: 10.1177/030006059001800603. [DOI] [PubMed] [Google Scholar]
- 24.Freeman S., Howard A., Foley P. Efficacy, cutaneous tolerance and cosmetic acceptability of desonide 0.05% lotion (Desowen) versus vehicle in the short-term treatment of facial atopic or seborrhoeic dermatitis. Australas J Dermatol. 2002;43:186–189. doi: 10.1046/j.1440-0960.2002.00592.x. [DOI] [PubMed] [Google Scholar]
- 25.Cabrera M.E. Treatment of severe or resistant corticosteroid-responsive dermatoses with Diprolene cream. J Int Med Res. 1984;12:163–169. doi: 10.1177/030006058401200305. [DOI] [PubMed] [Google Scholar]
- 26.Lodolo J.C. Diprolene cream in the treatment of severe or resistant corticosteroidresponsive dermatoses. J Int Med Res. 1984;12:114–120. doi: 10.1177/030006058401200209. [DOI] [PubMed] [Google Scholar]
- 27.Franz T.J., Parsell D.A., Halualani R.M. Betamethasone valerate foam 0.12%: A novel vehicle with enhanced delivery and efficacy. Int J Dermatol. 1999;38:628–632. doi: 10.1046/j.1365-4362.1999.00782.x. [DOI] [PubMed] [Google Scholar]
- 28.Breneman D., Fleischer A., Foley V. Presented at the World Congress of Dermatology, 2002; and the European Academy of Dermatology and Venereology. 2003. Clobetasol propionate 0.05% is equivalent as lotion or emollient cream in atopic dermatitis. Internal study number RD.06.SRE.180001.R02. [Google Scholar]
- 29.Galderma Laboratories . Galderma Laboratories, LP; Fort Worth, Tex: 2000. (LP. Study no. CR.U.9707.R02). Unpublished. [Google Scholar]
- 30.Stern R.S., Nijsten T., Feldman S.R. Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction. J Investig Dermatol Symp Proc. 2004;9:136–139. doi: 10.1046/j.1087-0024.2003.09102.x. [DOI] [PubMed] [Google Scholar]
- 31.Housman T.S., Mellen B.G., Rapp S.R. Patients with psoriasis prefer solution and foam vehicles: A quantitative assessment of vehicle preference. Cutis. 2002;70:327–332. [PubMed] [Google Scholar]
- 32.Feldman S.R., Housman T.S. Patients' vehicle preference for corticosteroid treatments of scalp psoriasis. Am J Clin Dermatol. 2003;4:221–224. doi: 10.2165/00128071-200304040-00001. [DOI] [PubMed] [Google Scholar]
- 33.Richards H.L., Fortune D.G., O'Sullivan T.M. Patients with psoriasis and their compliance with medication. J Am Acad Dermatol. 1999;41:581–583. [PubMed] [Google Scholar]
- 34.Williams H.C. Twice-weekly topical corticosteroid therapy may reduce atopic dermatitis relapses. Arch Dermatol. 2004;140:1151–1152. doi: 10.1001/archderm.140.9.1151. [DOI] [PubMed] [Google Scholar]