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      Scalp Psoriasis, Clinical Presentations and Therapeutic Management

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          Abstract

          Background: The scalp is a well-known predilection site for psoriasis. Many patients indicate that scalp psoriasis is both psychologically and socially distressing. Objective: The aim of the present investigation is to provide epidemiological data on the various manifestations of scalp psoriasis, as well as on its therapeutic management. Methods: A questionnaire, targeted on scalp psoriasis, was mailed to patient subscribers of a Dutch journal on psoriasis. In total 1,023 forms were returned and evaluated. Results: Remarkably, a relatively high occurrence of facial psoriasis (25%) and nail psoriasis (40%) was recorded. The dynamics of scalp psoriasis were rather similar to psoriasis at other sites with respect to the total duration of the disease and exacerbations/remissions. In 57% of the patients, psoriasis was psychologically and socially distressing, at least occasionally. Itch and scaling proved to be the leading symptoms, in terms of frequency of occurrence as well as in terms of distress. Therefore, these parameters should be regarded as primary efficacy criteria in the treatment of scalp psoriasis. On average, most patients were seen by the dermatologist 5 times a year. The majority of prescriptions (76%) was given by the dermatologist. The application of topical corticosteroids was by far the most frequent treatment modality. To our surprise, calcipotriol was used by 28% of patients. At the time of investigation calcipotriol was only available as ointment. Tar shampoos were used by 51% of the patients, although the clinical efficacy of such a shampoo has never been demonstrated in a controlled study. A remarkable observation was the lack of instruction on the duration of treatment and the frequency of applications. In fact, 72% of the patients used topical treatments, including topical corticosteroids, for more than 8 weeks, and 42% of the patients used an intermittent schedule of a few applications per week. Conclusions: Based on the present survey, the following profile for an optimal treatment of scalp psoriasis can be constructed: (1) effective applications a few times per week; (2) either a lotion or an emulsion, and (3) safety for long-term use.

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          Most cited references 3

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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.
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            Psoriasis. A questionnaire survey of 2,144 patients.

             N Farber,  C M Nall,  R. Bright (1968)
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              Cutaneous Mycobacterium chelonae Infection in a Presumably Immunocompetent Host

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                Author and article information

                Journal
                DRM
                Dermatology
                10.1159/issn.1018-8665
                Dermatology
                S. Karger AG
                1018-8665
                1421-9832
                1998
                1998
                18 December 1998
                : 197
                : 4
                : 326-334
                Affiliations
                Departments of Dermatology aUniversity Hospital Nijmegen, bZiekenhuis de Gelderse Vallei, Ede, cAcademic Medical Center Amsterdam, and dLeo Pharmaceutical Products, Weesp, The Netherlands
                Article
                18026 Dermatology 1998;197:326–334
                10.1159/000018026
                9873169
                © 1998 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 7, References: 13, Pages: 9
                Categories
                Clinical and Laboratory Investigations

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