512 Topical steroids effective for scalp psoriasis

August 22, 2017

written by Brian R McAvoy.

Clinical question
How effective are topical treatments for scalp psoriasis?

Bottom line
Corticosteroids of high or very high potency are more effective than vitamin D. The combination product of a corticosteroid and vitamin D is of small benefit over corticosteroid monotherapy. The combination product is superior to vitamin D alone. Corticosteroids of moderate, high and very high potency are similarly effective. There was not enough evidence to allow a final conclusion as to whether salicylic acid is of additional benefit in combination with corticosteroids. Little, and mostly unreliable, data suggested the efficacy of tar or dithranol preparations is limited. It might not make a difference whether corticosteroids are used once or twice daily.

On average, the overall quality of the evidence was moderate for the three most important comparisons that included corticosteroids, vitamin D and their combination product. Most findings were based on short-term therapies, with a duration of <6 months. Thirty of the 59 studies were either conducted or sponsored by the medication manufacturer.

There are a number of topical drugs in use for psoriasis, such as corticosteroids, vitamin D, tar-based preparations, tacrolimus, dithranol and salicylic acid. As psoriasis remains a long-term condition, it is of great importance to know which of the drugs work best, what kind of side effects they may have and how likely they are to occur.

Cochrane Systematic Review
Schlager JG et al. Topical treatments for scalp psoriasis. Cochrane Reviews, 2016, Issue 2. Art. No.: CD009687.DOI: 10.1002/14651858. CD009687.pub2. This review contains 59 studies involving 11,561 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.