Editorial ||FREE PAPER||

Garry M Walsh

Asthmatic and Allergy Inflammation Group, School of Medicine, University of Aberdeen, UK

This issue of Therapeutics and Clinical Risk Management contains four comprehensive review articles which focus on disorders of the skin. Psoriasis vulgaris represents the most common form of psoriasis. Symptoms include red, raised, scaly lesions that usually occur symmetrically in areas subjected to trauma such as the elbows and knees. Although not considered life-threatening, this is an unpleasant, distressing condition that impacts on quality of life and patient well-being. The chronic nature of the condition requires long-term therapy thereby raising compliance and safety issues. The pathogenesis of psoriasis vulgaris is not well understood but is thought to involve a complex interaction between genetic and environmental factors that impact on innate and acquired immunity. This results in an inflammatory cutaneous response in which T cells, dendritic cells and pro-inflammatory chemokines play particularly important roles. Most treatments are topical with corticosteroids and vitamin D3 analogues being the treatment of choice. Efstratios Vakirlis and colleagues (2008) provide a comprehensive review of the efficacy of treating psoriasis vulgaris with a topical treatment that combines calcipotriol, a vitamin D analog with the corticosteroid betamethasone dipropionate. The authors review the mechanisms by which the two compound ointments (Dovobet^®, Daivobet^®, Taclonex^®) attenuate the inflammatory cascade that results in the symptoms of psoriasis. The combination of the two therapies has a positive additive effect with lesions clearing more quickly compared with separate application of corticosteroids and calcipotriol. The authors also highlight the technical demands of creating the dual formulation due to the tendency of calcipotriol and topical steroids to inactivate each other when mixed in a single formulation. The available randomized clinical trials with the combination medication are comprehensively reviewed together with safety and tolerability for the treatment. It appears that the requirement for a once daily application and a rapid onset of action improves patient compliance. Overall the authors’ opinion is that dual formulation of calcipotriol and topical steroids is a safe and effective treatment for psoriasis vulgaris either as initial therapy or as adjunct therapy in patients who also require systemic treatment or phototherapy.