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Current Medical Research and Opinion
Vol. 4,No. 5, 1976
Local treatment of psoriasis of the scalp with clobetasol propionate and betamethasone17,21-dipropionate: a doubleblind comparison
Allan Lassus, M.D.
Curr. Med. Res. Opin., (1976),4, 365.
Department of Dermatology, University Central Hospital, Helsinki, Finland
Received: 15th July 1976
Summary A double-blind evaluation was carried out in 40 patients with moderate to severe psoriasis of the scalp to assess the effectiveness of a 0.05% alcoholic solution of’ clobetasol propionate as compared with a 0.05 % alcoholic solution of betamethasone17,2I-dipropionate. Patients were treated on a non-selective basis with a twice a da!, application for 2 weeks. When comparing the effects on the parameters scaling, induration, erythema and itching it was concluded that clobetasol propionate was superior to betamethasone-l7,21-dipropionate as an antipsoriatic compound. Clobetasol propionate did not cause any side-effects, while 2 of the patients using betamethasone-1 7,21-dipropionate developed a .forehead,folliculitis during the second week of treatment.
Key words: Clobetasol propionate - betamethasone- 17,21-dipropionate - derniatologir agents - psoriasis
Introduction All forms of psoriasis are difficult to treat but this applies especially to the scalp lesions. The halogenated steroids are the main preparations used to control scalp lesions and the development of newer, more potent halogenated compounds has been of much help to the clinicians because of their cosmetic advantages and efficacy. In a recent report2 it was found that a new steroid, clobetasol propionate in alcoholic solution (‘Dermovate’ Scalp Applicationt) applied twice daily, cured almost 80% of severe psoriatic scalp lesions during a 2-week treatment period. It was therefore of interest to compare this new steroid with another highly potent steroid, betamethasone-l7,21-dipropionate(‘Diproderm’ Alcoholic Solution$) in the treatment of psoriatic scalp lesions.
Patients and methods Forty members of the Finnish Psoriasis Association volunteered for the trial. The requirement for acception was that the patients had moderate to severe psoriatic ~~
t‘Dermovate’, trade mark Glaxo
$‘Diproderm’, trade mark Schering Corporation, U.S.A.
365
Curr Med Res Opin Downloaded from informahealthcare.com by University of Otago on 12/29/14 For personal use only.
Local treatment of psoriasis of the scalp with clobetasol propionate and betamethasone-17,21-dipropionate:a double-blindcomparison
scalp lesions and that the lesions had not been actively treated for 1 month before the trial started. All patients were over 15-years old. On entry to the trial, the patients were non-selectively divided into two groups and were allocated to receive treatment with either clobetasol propionate (0.05 %) or betamethasone-I 7,21-dipropionate (0.05 %) in alcoholic solution. Patients were instructed to apply the solution, without rubbing, to their scalp lesions twice a day. The treatment was started without prior use of keratolytic compounds. Before beginning the trial, the degree of scaling, induration, erythema and itching was rated as severe, moderate, mild or absent. The parameters were assessed again after 1 and 2 weeks of treatment.
Results Details of the assessments of severity of the scalp lesions before the start of the trial and after 1 and 2 weeks of treatment are given in Table I. Table I. Severity of psoriatic lesions before treatment and response to clobetasol propionate and betamethasone-17,21-dipropionateduring a 2-weektreatment period
Parameter Scaling Before treatment After 1 week After 2 weeks Induration Before treatment After I week After 2 weeks Erythema Before treatment After 1 week After 2 weeks Itching Before treatment After 1 week After 2 weeks
Clobetasol propionate Severe
Moderate Mild
10 1 1
10 3
13
4 4
13
5
Betamethasone-l7,21-dipropionate Absent
Severe
8
12 6
4 13
6
1
3 10 4
15
5 5 2
2 11 9
4 9
6 1
7 7 3
2 12 17
12
8
Moderate Mild
10 6 3
11
2 6
9
9
2
5
10
5
3 I1
2 2
8 6 4
5 13 16
8
12 15
7 1
2 12
Absent
6 1
By chance the patients treated with clobetasol propionate had somewhat more severe lesions before treatment. After 1 week of treatment there was a considerable decrease in the severity of the parameters in both groups. However, the induration of the lesions was completely or almost completely absent in 80% of the patients treated with clobetasol propionate as compared with 55 ”/, of the patients treated with betamethasone-l7,21-dipropionate.The decrease of erythema of the lesions showed a similarly greater response in the clobetasol propionate group. In both groups there was a marked decrease in scaling and itching of the lesions. After 2 weeks of treatment moderate induration and erythema were found in 15% of patients treated with clobetasol propionate compared with 60% of 366
Allan Lassus
Curr Med Res Opin Downloaded from informahealthcare.com by University of Otago on 12/29/14 For personal use only.
patients treated with betamethasone- I 7,2 1-dipropionate. One third of the patients treated with clobetasol propionate still showed some scaling while this was the case in 14 of the 20 patients treated with betamethasone-I 7,21-dipropionate. In both groups there was little or no itching. In the group treated with clobetasol propionate no side-effects were observed. Two of the patients treated with betamethasone-I 7,2 1-dipropionate developed folliculitis of the forehead during the second week of treatment.
Conclusions The results of the present short-term study clearly demonstrate the superiority of dobetasol propionate compared with betamethasone-1 7,21-dipropionate in the treatment of psoriatic scalp lesions. The results are in conformity with a comparison of the effectiveness of the two compounds in the treatment of other psoriatic skin lesions.’ The study further stresses the advantages of clobetasol propionate as an antipsoriatic compound, with a high cure rate and a minimum of side-effects during the short period of treatment needed.
References 1. Lassus, A., (1976). Local treatment of psoriasis with clobetasol propionate and betamethasone17,21-dipropionate:a double-blind comparison. Curr. Med. Res. Opin., 3,693. 2. Lassus, A., (1976). Local treatment of psoriasis of the scalp with clobetasol propionate in alcoholic solution: a comparison of once and twice a day application. Cirrr. Med. Res. Opin., 4,214.
367
Current Medical Research and Opinion
Vol. 4,No. 5, 1976
Local treatment of psoriasis of the scalp with clobetasol propionate and betamethasone17,21-dipropionate: a doubleblind comparison
Allan Lassus, M.D.
Curr. Med. Res. Opin., (1976),4, 365.
Department of Dermatology, University Central Hospital, Helsinki, Finland
Received: 15th July 1976
Summary A double-blind evaluation was carried out in 40 patients with moderate to severe psoriasis of the scalp to assess the effectiveness of a 0.05% alcoholic solution of’ clobetasol propionate as compared with a 0.05 % alcoholic solution of betamethasone17,2I-dipropionate. Patients were treated on a non-selective basis with a twice a da!, application for 2 weeks. When comparing the effects on the parameters scaling, induration, erythema and itching it was concluded that clobetasol propionate was superior to betamethasone-l7,21-dipropionate as an antipsoriatic compound. Clobetasol propionate did not cause any side-effects, while 2 of the patients using betamethasone-1 7,21-dipropionate developed a .forehead,folliculitis during the second week of treatment.
Key words: Clobetasol propionate - betamethasone- 17,21-dipropionate - derniatologir agents - psoriasis
Introduction All forms of psoriasis are difficult to treat but this applies especially to the scalp lesions. The halogenated steroids are the main preparations used to control scalp lesions and the development of newer, more potent halogenated compounds has been of much help to the clinicians because of their cosmetic advantages and efficacy. In a recent report2 it was found that a new steroid, clobetasol propionate in alcoholic solution (‘Dermovate’ Scalp Applicationt) applied twice daily, cured almost 80% of severe psoriatic scalp lesions during a 2-week treatment period. It was therefore of interest to compare this new steroid with another highly potent steroid, betamethasone-l7,21-dipropionate(‘Diproderm’ Alcoholic Solution$) in the treatment of psoriatic scalp lesions.
Patients and methods Forty members of the Finnish Psoriasis Association volunteered for the trial. The requirement for acception was that the patients had moderate to severe psoriatic ~~
t‘Dermovate’, trade mark Glaxo
$‘Diproderm’, trade mark Schering Corporation, U.S.A.
365
Curr Med Res Opin Downloaded from informahealthcare.com by University of Otago on 12/29/14 For personal use only.
Local treatment of psoriasis of the scalp with clobetasol propionate and betamethasone-17,21-dipropionate:a double-blindcomparison
scalp lesions and that the lesions had not been actively treated for 1 month before the trial started. All patients were over 15-years old. On entry to the trial, the patients were non-selectively divided into two groups and were allocated to receive treatment with either clobetasol propionate (0.05 %) or betamethasone-I 7,21-dipropionate (0.05 %) in alcoholic solution. Patients were instructed to apply the solution, without rubbing, to their scalp lesions twice a day. The treatment was started without prior use of keratolytic compounds. Before beginning the trial, the degree of scaling, induration, erythema and itching was rated as severe, moderate, mild or absent. The parameters were assessed again after 1 and 2 weeks of treatment.
Results Details of the assessments of severity of the scalp lesions before the start of the trial and after 1 and 2 weeks of treatment are given in Table I. Table I. Severity of psoriatic lesions before treatment and response to clobetasol propionate and betamethasone-17,21-dipropionateduring a 2-weektreatment period
Parameter Scaling Before treatment After 1 week After 2 weeks Induration Before treatment After I week After 2 weeks Erythema Before treatment After 1 week After 2 weeks Itching Before treatment After 1 week After 2 weeks
Clobetasol propionate Severe
Moderate Mild
10 1 1
10 3
13
4 4
13
5
Betamethasone-l7,21-dipropionate Absent
Severe
8
12 6
4 13
6
1
3 10 4
15
5 5 2
2 11 9
4 9
6 1
7 7 3
2 12 17
12
8
Moderate Mild
10 6 3
11
2 6
9
9
2
5
10
5
3 I1
2 2
8 6 4
5 13 16
8
12 15
7 1
2 12
Absent
6 1
By chance the patients treated with clobetasol propionate had somewhat more severe lesions before treatment. After 1 week of treatment there was a considerable decrease in the severity of the parameters in both groups. However, the induration of the lesions was completely or almost completely absent in 80% of the patients treated with clobetasol propionate as compared with 55 ”/, of the patients treated with betamethasone-l7,21-dipropionate.The decrease of erythema of the lesions showed a similarly greater response in the clobetasol propionate group. In both groups there was a marked decrease in scaling and itching of the lesions. After 2 weeks of treatment moderate induration and erythema were found in 15% of patients treated with clobetasol propionate compared with 60% of 366
Allan Lassus
Curr Med Res Opin Downloaded from informahealthcare.com by University of Otago on 12/29/14 For personal use only.
patients treated with betamethasone- I 7,2 1-dipropionate. One third of the patients treated with clobetasol propionate still showed some scaling while this was the case in 14 of the 20 patients treated with betamethasone-I 7,21-dipropionate. In both groups there was little or no itching. In the group treated with clobetasol propionate no side-effects were observed. Two of the patients treated with betamethasone-I 7,2 1-dipropionate developed folliculitis of the forehead during the second week of treatment.
Conclusions The results of the present short-term study clearly demonstrate the superiority of dobetasol propionate compared with betamethasone-1 7,21-dipropionate in the treatment of psoriatic scalp lesions. The results are in conformity with a comparison of the effectiveness of the two compounds in the treatment of other psoriatic skin lesions.’ The study further stresses the advantages of clobetasol propionate as an antipsoriatic compound, with a high cure rate and a minimum of side-effects during the short period of treatment needed.
References 1. Lassus, A., (1976). Local treatment of psoriasis with clobetasol propionate and betamethasone17,21-dipropionate:a double-blind comparison. Curr. Med. Res. Opin., 3,693. 2. Lassus, A., (1976). Local treatment of psoriasis of the scalp with clobetasol propionate in alcoholic solution: a comparison of once and twice a day application. Cirrr. Med. Res. Opin., 4,214.
367
