Topical treatment with steroids and vitamin D analogue foam effective in long-term management of psoriasis

France: In a new study conducted by Marjorie Heim and team it was found that in psoriasis patients combined topical treatment with Calcipotriol/Betamethasone foam is effective in reducing cellular influx into lesional skin. Further, this effect was found to be superior to emollient or betamethasone alone.

The findings of this study were published in Experimental Dermatology. 

A randomized, double-blind, monocentric study including 30 patients was conducted. Patients received either a placebo, a combination of betamethasone and calcitriol, betamethasone foam alone, or clobetasol propionate ointment. Before and four weeks after treatment, 4-mm skin samples were obtained from lesional and nonlesional areas. By using immunofluorescence, the cellular infiltration, IFN, and IL-17 were examined. Each patient was in charge of themselves. The evolution of skin inflammation was investigated concurrently with alterations in the tPASI clinical score and epidermal thickness of the patients.

The key findings of this study were as follows:

1. Increased epidermal thickness, as well as an increase in CD8+ T cells, NK cells, and neutrophils that produce IL-17 and IFN, were seen in lesional skin.

2. Each and every course of therapy decreased epidermal thickness while raising patients' tPASI scores.

3. Only the combination Calcipotriol/Betamethasone foam entirely eliminated dermal and epidermal CD8+ T cell influx, decreased the amount of CD8+IFN+ cells (but not CD8+IL-17+ cells), and dramatically decreased the number of MPO+ neutrophils, which were mostly IL-17+.

4. NK cells were unaffected by any of the treatments.

In conclusion, its previously reported clinical effectiveness may be explained by its distinct and speedy capacity to prevent both innate immunological neutrophilia and adaptive CD8+ T cell infiltration into the skin, which was not seen with the other therapies.

Reference: 

Heim, M., Irondelle, M., Duteil, L., Cardot‐Leccia, N., Rocchi, S., Passeron, T., & Tulic, M. K. (2022). Impact of topical emollient, steroids alone or combined with calcipotriol, on the immune infiltrate and clinical outcome in Psoriasis. In Experimental Dermatology. Wiley. https://doi.org/10.1111/exd.14657