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In the past, topical steroids were used twice a day. For some patients, certain drugs may work just as well if applied once a day. Both high-potency steroids, and possibly medium-strength steroids, such as triamcinolone (Aureocort, Tri-Adcortyl), may be beneficial as a once-daily treatment.
However, corticosteroids used alone are not enough for most patients. Combining topical steroids with other topical drugs (see below) is often needed. Many patients also need oral medicines.
Side Effects. The more powerful the corticosteroid, the more effective it is. But more powerful steroid medications also have a higher risk for severe side effects, which may include:
- Acne
- Burning
- Dilated (widened) blood vessels
- Skin dryness
- Skin irritation
- Loss of skin color
- Thinning of the skin; skin may become shiny, fragile, and easily broken
Loss of Effectiveness. In most cases, patients become tolerant to the effects of the drugs, and the drugs no longer work as well as they should. Some experts recommend using intermittent therapy (also called weekend or pulse therapy). This type of treatment involves applying a high-potency topical medication for 3 full days each week.
Topical Vitamin D3-Related Treatments
A topical form of vitamin D3, calcipotriene (Dovonex) is proving to be both safe and effective. It is now available in a foam preparation, which makes using it even easier. Several other topical vitamin D3-related drugs that are showing promise include maxacalcitol, tacalcitol, and calcitriol.
Calcipotriene appears to:
- Block skin cell reproduction
- Enhance the maturity of keratinocytes (the impaired skin cells in psoriasis)
- Act as an anti-inflammatory
It works just as well as moderate topical corticosteroids, short-term anthralin, and coal tar in improving mild-to-moderate plaque psoriasis. But unlike with steroids, patients do not develop thinning of the skin or tolerance to the drug.
Using the drug in combination with other topical and body-wide treatments may improve its effectiveness. Calcipotriene doesn't work as well as the highest potency corticosteroids, but combining both medications is proving to be more effective than taking either one alone. Taclonex, an ointment containing both calcipotriol and betamethasone, is available for the treatment of adults with psoriasis. Studies show the combination works better than either drug alone.
Combining vitamin D ointments with systemic medicines, notably methotrexate, acitretin, or cyclosporine, increases its effectiveness. Because combining medications allows patients to use lower doses of both medications, combination treatments reduce side effects.
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Review Date: 10/21/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine,
Harvard Medical School. Also reviewed by David Zieve, MD, MHA,
Medical Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
