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Efficacy of Iralfaris shampoo in the treatment of scalp psoriasis: a videodermoscopy evaluation prospective study in 70 patients.

AIM
This work has the aim to test the sensibility of VSCAPSI method in the evaluation of effectiveness of a medicated shampoo for the treatment of scalp psoriasis. Psoriasis is a chronic inflammatory skin disease histologically characterized by proliferation and loss of differentiation of keratinocytes, angiogenesis with vasodilatation and increased permeability, and inflammation. Scalp involvement is a common clinical feature of psoriasis, that is present in the 25% of patients who suffer of it. Videodermoscopy (VD) permits a magnified view of the surface components of the epidermis and papillary dermis, which are not visible to the naked eye, together with the ability to capture digitally the viewed images and to store them for later use. Moreover videodermoscopy is a non-invasive technique, used to analyze cutaneous peripheral microcirculation. Therefore VD could be an useful tool in evaluating the efficacy of treatments for scalp psoriasis. The clinical benefit of currently available medicated shampoos for the treatment of scalp psoriasis is restricted, due to their limited efficacy, low cosmetic appeal and safety and tolerability problems. Therefore effective and safe products are needed especially for the long term management of scalp psoriasis. A specific shampoo designed for the scalp hygiene in psoriatic patients has been recently developed. This shampoo contains urea, glycolic acid, salicylic acid, icthyol pale and laureth 9 (polidocanol). Aim of the study was to evaluate in a 12-week prospective monocenter, open-study the efficacy and tolerability of an emollient, keratolytic shampoo (Iralfaris shampoo ISDIN, Barcelona; Ir-S) applied three times a week in patients with scalp psoriasis. The efficacy of the shampoo has been valuated with VSCAPSI.


METHODS
Seventy subjects with mild to moderate/severe scalp psoriasis were enrolled in the trial, after their informed consent. Efficacy was assessed using a specific and validated videodermoscopy scalp psoriasis severity index (VSCAPSI) score, performed at baseline, after 45 and 90 days. Patients were evaluated for itching.


RESULTS
VSCAPSI score at baseline was 8.5. Ir-S induced a significant reduction of VSCAPSI score in comparison with baseline value both after 45 and 90 days of treatment. The use of shampoo lead to a progressive reduction of VSCAPSI score getting a score of 4.2 at T45 and a score of 4.0 at T90 (P=0.001 vs. baseline). The use of Ir-S has significantly reduced the percentage of patients reporting itching sensation.


CONCLUSION
The treatment was safe and well-tolerated with an high cosmetic acceptance. Ir-S is a good alternative to other medicated shampoo in the treatment of mild to moderate scalp psoriasis. Moreover, in the treatment of severe scalp psoriasis, it can lead to an improvement if associated with topical medications.