Summary of findings 2. Topical vitamin D derivative compared to placebo for chronic palmoplantar pustulosis.
| Topical vitamin D derivative compared to placebo for chronic palmoplantar pustulosis | ||||||
| Patient or population: chronic palmoplantar pustulosis Setting: outpatients Intervention: topical vitamin D derivative Comparison: placebo | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with placebo | Risk with topical vitamin D derivative | |||||
| Proportion of participants cleared or almost cleared in the short term (8 weeks) | Study population | RR 7.83 (1.85 to 33.12) | 188 (1 RCT) | ⊕⊕⊝⊝ Lowa | Another study compared topical vitamin D derivative to placebo (within‐study design; side randomised) (Muro 2016). Co‐intervention (topical betamethasone butyrate propionate) was applied on both sides. Combined therapy was reported as significantly superior to monotherapy for each assessed symptom (erythema, pustules/vesicles, hyperkeratosis). | |
| 22 per 1000 | 168 per 1000 (40 to 712) | |||||
| Proportion of participants with adverse effects serious or severe enough to have caused withdrawal ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | Not reported |
| Proportion of participants with at least 50% improvement in their quality of life ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | Not reported |
| Proportion of participants achieving a 50% reduction in disease severity ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | Not reported |
| Proportion of participants without relapse in the long term ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | Not reported |
| Proportion of participants with adverse effects ‐ measured over 8 weeks | Study population | RR 0.87 (0.64 to 1.19) | 188 (1 RCT) | ⊕⊕⊕⊝ Moderateb | Reported adverse events were mild local irritation, pruritus, and mild haematological or urinary test abnormalities In Muro 2016, none of the participants in both groups reported any side effects. |
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| 495 per 1000 | 430 per 1000 (317 to 589) | |||||
| Ease of compliance to an intervention or a treatment ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | Not reported |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence. High quality: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded by two levels to low‐quality evidence. One level due to study limitations because of incomplete reporting and other items were rated as unclear risk of bias. One further level due to imprecision as there is a large confidence interval for this result.
bDowngraded by one level to moderate‐quality evidence for study limitations because of incomplete reporting and other items rated as unclear risk of bias.