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University Hospital Nijmegen, Nijmegen, The Netherlands.
Br J Dermatol 2009;160:170–6.
Editor’s note: Treatment of scalp psoriasis is often a major therapeutic challenge as many topical treatments are cosmetically unacceptable and difficult to apply, resulting in poor compliance. A new two-compound scalp formulation (Xamiol®; Leo Pharma A/S, Ballerup, Denmark) containing a vitamin D
3 analogue (calcipotriol 50
µg/g) plus a potent corticosteroid (betamethasone dipropionate 0.5 mg/g) has been developed for once-daily treatment of scalp psoriasis. In this study, the efficacy and safety of this new scalp formulation was compared with the active ingredients as single compounds in the same vehicle. The study was designed as a multicenter, prospective, randomized, double-blind, parallel-group study. A total of 568 patients with scalp psoriasis involving >10% of the scalp used the two-compound formulation, 563 patients used betamethasone dipropionate 0.5 mg/g, and 268 patients were prescribed calcipotriol 50
µg/g. The treatments were used once daily for up to 8 weeks. Compliance was similar for the three groups. The proportion of patients with “absence of disease” or “very mild disease” according to the investigators at week 8 was significantly higher in the two-compound group (68.4%) compared with the betamethasone dipropionate (61.0%; p=0.0079) and calcipotriol (43.3%; p<0.0001) alone groups. By week 2, the two-compound treatment was already significantly more effective than the two other treatments (49% vs. 38.4% betamethasone dipropionate and 15.7% calcipotriol; p=0.0001 and <0.0001, respectively). The proportion of patients experiencing at least one adverse event was similar in the two-compound and betamethasone dipropionate groups, but was significantly greater in the calcipotriol group compared with the two-compound group.