Treatment of the capillitium often presents a particular challenge in topical therapy. In addition to the condition of the skin, the patient’s preferences are also an important criterion in choosing the appropriate preparation. In the present case series, a spray foam with the fixed combination of calcipotriol and betamethasone dipropionate proved effective.
In a Cochrane review on the topical treatment of scalp psoriasis, the combination therapy of 50 µg calcipotriol (Cal) and 0.5 mg betamethasone dipropionate (BD) was found to be equivalent to topical corticosteroids (TCS) [1]. The betamethasone dipropionate contained in the fixed combination Cal/BD is a steroid of strength class III, calcipotriol belongs to the group of vitamin D3 derivatives. Foam galenics usually allow the active ingredients to be better absorbed through the skin compared to ointment or gel galenics [2]. A case series published in 2022 suggests that patients who do not respond to TCS monotherapy may benefit from conversion to the fixed combination of Cal/BD spray foam in practice [3].
Study design
In the 2019 case series conducted in a Swiss dermatology practice, 10 patients with active scalp psoriasis of varying severity were included [3]. The average age of the participants was 52 years (age range 33-76 years), and nine of the patients were female. All participants had undergone various topical treatments prior to study inclusion. 7 of the 10 included patients had been treated with TCS (most in combination with keratolytics or antifungal shampoos) but did not achieve adequate control of their scalp psoriasis. Patients who required systemic therapy were not included in the study. The 10 participants were instructed to apply the Cal/BD fixed combination once daily before bedtime for four weeks. They were instructed to apply the Cal/BD spray foam directly to the affected scalp areas with a finger and not to spray directly onto the plaques. They were also instructed to first lather the shampoo on their dry hair the following morning before rinsing. The severity of scalp psoriasis was assessed using a 5-point scale (box). At baseline, two patients suffered from mild, five from moderate, and three from severe scalp psoriasis. In 8 of 10, scalp psoriasis was the only manifestation of psoriasis.
Treatment course and results
After four weeks of treatment with Cal/BD spray foam, scalp psoriasis improved by ≥2 points on the 5-point scale in all 10 patients. 8 of 10 study participants achieved an appearance-free/nearly appearance-free scalp without the need for further keratolytic treatment [3]. The treatment results at a glance:
- 2 Patients with mild scalp psoriasis who had been treated with TCS or zinc pyrithione shampoo before study entry achieved an appearance-free scalp.
- 5 patients with moderate scalp psoriasis who – except for one patient who had received only ciclopiroxolamine shampoo before the start of the study – had all been treated with TCS (mostly in combination with tar or ciclopiroxolamine shampoo or salicylic acids) also achieved an appearance-free scalp
- 3 Patients with severe scalp psoriasis who had received combination therapy of TCS or salicylic acid and a tar, zinc pyrithione, or selenium disulfide shampoo prior to study entry showed improvement in scalp psoriasis of at least two points; two of the patients were nearly free of appearance.
Conclusion: rapid therapy response and high patient satisfaction
In summary, the spray foam with the Cal/BD-Fix combination achieved a rapid therapeutic response with very good tolerability. No adverse events were observed. Patients were very satisfied with the ease of use, efficacy and safety of Cal/BD spray foam. This is in agreement with the results of an Italian observational study in which 36.7% of the 256 psoriasis patients included had scalp involvement, and a large majority of those who had had received the spray foam with the Cal/BD fixed combination, rated this treatment option as more effective, easier to use, and better tolerated compared with previous topical treatments [4].
Correct use of the preparation is crucial
The authors of the present case series emphasized that instruction was an important factor in the treatment success of topical therapy [3]. Patients had been instructed to apply the spray foam once daily before bedtime to ensure adequate overnight exposure time. It is important to explain that the foam should not be sprayed directly onto the scalp, as this would result in a greasy, cosmetically unattractive film on the hair and would not allow sufficient direct contact of the foam with the skin. Therefore, patients were instructed to first spray the foam on their hand and then apply it to the plaques with their fingers. Also important was the instruction to lather the shampoo directly on dry hair the following morning and only then rinse with water, the study authors said.
Literature:
- Schlager JG, et al: Topical treatments for scalp psoriasis. Cochrane Database Syst Rev 2016;2:009687.
- Drug Information, https://compendium.ch, (last accessed Sept. 22, 2022).
- Régnier A, Trüeb RM: Efficacy of Calcipotriol/Betamethasone Dipropionate Fixed-Combination Aerosol Foam in the Treatment of Localized Scalp Psoriasis: A Real-Life Case Series from Switzerland. Dermatol Ther (Heidelb) 2022; 12(9): 2181-2188.
- Campanati A, et al; LION Study Group Patient satisfaction with calcipotriol/betamethasone dipropionate cutaneous foam for the treatment of plaque psoriasis: the LION real-life multicenter prospective observational cohort study. Dermatol Ther 2021; 34(5): e15077.
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