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Cochrane Database of Systematic Reviews

Topical treatments for chronic plaque psoriasis

Overview of attention for article published in Cochrane database of systematic reviews, April 2009
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Topical treatments for chronic plaque psoriasis
Published in
Cochrane database of systematic reviews, April 2009
DOI 10.1002/14651858.cd005028.pub2
Pubmed ID

Mason, Anne R, Mason, James, Cork, Michael, Dooley, Gordon, Edwards, Gladys


Chronic plaque psoriasis is the most common type of psoriasis and is characterised by redness, thickness and scaling. First line management of chronic plaque psoriasis is with topical treatments, including vitamin D analogues, topical corticosteroids, tar-based preparations, dithranol, salicylic acid and topical retinoids. To compare the effectiveness, tolerability and safety of topical treatments for chronic plaque psoriasis with placebo; to compare vitamin D analogues with other topical treatments. The Cochrane Skin Group's Trials Register was searched (2004/12). To update an unpublished 2002 review we also searched CENTRAL in The Cochrane Library (Issue 1,2005); MEDLINE (to 2005/02); EMBASE (to 2005/08); Science Citation Index (to 2005); Biosis (to 2005); Dissertation Abstracts (all publication years); Inside Conferences (all publication years); SIGLE (to 2005); National Research Register (all projects with a start date of 2001 to 2005); metaRegister of Current Controlled Trials. Randomised trials comparing treatments against placebo or against vitamin D analogues in people with chronic plaque psoriasis. One author extracted study data and assessed study quality. A second author checked these data. We routinely contacted triallists and companies for missing data. We extracted data on withdrawals and adverse events. The review included 131 RCTs with 21,448 participants. Vitamin D was significantly more effective than placebo, although there was a wide variation in effect size with the standardised mean difference (SMD) ranging from -0.82 (95% CI -1.34 to -0.29) to -1.90 (95% CI -2.09 to -1.71). With one exception, all corticosteroids performed better than placebo, with potent corticosteroids (SMD: -0.95 (95% CI: -1.11 to -0.80; I(2): 61.1%; 17 studies; 2386 participants)) having smaller benefits than very potent corticosteroids (SMD: -1.29 (95% CI: -1.45 to -1.13; I(2): 53.2%; 11 studies; 1571 participants)). Dithranol and tazarotene performed better than placebo. Head-to-head comparisons of vitamin D against potent or very potent corticosteroids found no significant differences. However, combined treatment with vitamin D /corticosteroid performed significantly better than either vitamin D alone or corticosteroid alone. Vitamin D performed better than coal tar, but findings relative to dithranol were mixed. Potent corticosteroids were less likely than vitamin D to cause local adverse events. No comparison of topical agents found a significant difference in systemic adverse effects. Corticosteroids perform as well as vitamin D analogues and are associated with a lower incidence of local adverse events. Further research is required to inform long-term maintenance treatment.

Mendeley readers

The data shown below were compiled from readership statistics for 67 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Japan 1 1%
United Kingdom 1 1%
India 1 1%
Belgium 1 1%
Unknown 63 94%

Demographic breakdown

Readers by professional status Count As %
Researcher 10 15%
Student > Master 10 15%
Student > Bachelor 10 15%
Other 7 10%
Student > Ph. D. Student 4 6%
Other 10 15%
Unknown 16 24%
Readers by discipline Count As %
Medicine and Dentistry 36 54%
Pharmacology, Toxicology and Pharmaceutical Science 6 9%
Agricultural and Biological Sciences 4 6%
Chemistry 2 3%
Psychology 1 1%
Other 3 4%
Unknown 15 22%