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Evaluation of Topical Drug Treatment in Psoriasis

Background: During the last decade important innovations in the topical treatment of psoriasis have been accomplished, and important investments in new drug development for psoriasis are planned. Methods: A survey was conducted among psoriatic patients in order to quantify the present mode of use of topical drugs by the patients, the mode of prescription by their doctors and the compatibility of actual use and instructions to the patients. Results: Major observations are: The distribution of lesions, in particular on the scalp and soles, justifies major investments in the development of a treatment at these locations. Calcipotriol and topical corticosteroids (classes III and IV) are by far the most frequently prescribed topical drugs. Although at the time of investigation, calciopotriol was only available as ointment in the Netherlands, it is prescribed twice as often as clobetasol which is both available as an ointment and cream. Dermatologists are responsible for approximately 2/3 and general practitioners for 1/3 of the prescriptions. The prescription by general practitioners also comprises the continuation of prescriptions by the dermatologist. The duration of topical treatment is unrestricted in the majority of patients. However, use of up to 8 weeks is only seldom practised. Therefore, long-term safety and efficacy data of these drugs are mandatory for any topical treatment. Although twice daily treatment was advised in 50% of all patients, this treatment frequency was followed in only 33% of them. Greasiness accounted for non-compliance in 11% of the patients. Less frequent applications were desired by 38% of the patients, including patients on a once-a-day regimen. Most patients preferred the cream formulation. However, the variability of the expression of psoriasis (dry cracked exudative or superficially scaling lesions) required the availability of both cream and ointment formulations. Conclusion: An optimal treatment of psoriasis requires a spectrum of topical drugs and their formulations in different vehicles.