Created By :

Masrida Rezki (2008730086)

Adviser :

dr. Bowo Wahyudi, Sp.KK

Dermatovenereology RSUD Banjar

Universitas Muhammadiyah Jakarta
Psoriasis
Psoriasis is a common chronic inflammatory skin condition
and, although generally not life threathening, it can have a
profound impact on physical, physicological and social
well-being.

Nearly 80% patients with psoriasis is

plaque psoriasis.

The skin changes in patients with

psoriasis takes place rapidly at about
2-4 days, (it can even happen faster)
that a lot of skin cell turnover and
thickened.
Psoriasis Treatment
The psoriasis treatment is there
only to suppress the symptoms,
improve skin condition, relieves
itch.

Psoriasis treatment is usually done in a variety of ways

starting with a topical treatment, systemic or by irradiation
with UVB rays. Both treatments only help reduce the disease and
do not heal at all, so any time the disease can recur.
Backgrounds
While recent advances and investment in high-cost biological
therapies have revolutionized outcomes for people with severe
disease , comparatively little attention has been paid to topical
therapy, which forms the cornerstone of management for the majority of
people with psoriasis.

Investigator set out to summarize evidence the relative efficacy,

safety and tolerability of different topical treatments used in plaque
psoriasis.

Finally, they undertook a systematic review and meta-analysis of

randomized trial data of U.K licensed topical therapies.
Objective
i. To summarize the evidence on topical treatments in
chronic plaque psoriasis (stratified for trunk and limbs,
and scalp) to allow comparison of their efficacy,
tolerability and safety

ii. To synthesize data on efficacy to inform original cost-

effectiveness modelling
Search strategy and
selection criteria
Abstracts were screened and articles that appeared to meet
the inclusion criteria were assessed further. Studies were
excluded if they were not published as full reports, due to
high risk of bias.
Eligible studies were required to have at least 25 people in
each study arm and to report induction or maintenance of
remission.
The unit of randomization could be the individual patients or
one side of the body.
Interventions Outcomes
Vitamin D and vitamin D The primary outcome was the
proportion of patients achieving
analogue clear or nearly clear status on
Potent or very potent either the Investigators
corticosteroids Assesment of Overall Global
Improvement (IAGI) or dynamic
Combination of vitamin D Physicians Global Assessment
and potent (PGA) or static PGA.
corticosteroids either as
a TCF or TCA The secondary outcome was
clear or nearly clear status as
Tar assessed by either the Patients
Dithranol Assessment of Overall Global
(PAGI) or the statics patients
Retinoids
Global Assessment.
Statistical Analysis
Data were stratified according to the site of psoriasis : (i) trunk
and limbs; and (ii) scalp.
A series of pairwise meta-analyses for the primary and secondary
outcome for induction of remission produced 12 direct comparisons for
trunk and limb psoriasis and 10 for scalp psoriasis.
The analysis was performed in WinBUGS 19 using a multi-arm, random
effects logistic regression model, with parameter estimated by Markov
chain Monte Carlo Simulation.
Results
Results
For trunk and limb psoriasis approximately half of the studies included
populations with moderate to severe psoriasis assessed by PASI, PGA or
BSA, while others included either mild to moderate psoriasis, any disease
severity as an inclusion criterion.
For scalp psoriasis, the majority of studies included those with moderate to
severe scalp involvement, with three stipulating mild to moderate scalp
disease and three allowing any severity any severity to be included.
In pairwise result, the most rapid improvement in response occured during
the first 2-4 weeks for corticosteroids, and the first 4 weeks for vitamin D
analogue containing intervention, dithranol, and coal tar.
Results
In NMA results for trunk and limb psoriasis, all active interventions were
significantly more effective than placebo twice daily, except coal tar used
once daily and retinoids. Very potent steroids were the most effective
treatment option.
Results
The TCF product was significantly more effective than once daily application of
vitamin D analogues, potent corticosteroids, retinoids or coal tar.
In NMA results for scalp psoriasis, all active interventions were more efficacious
than placebo applied twice daily, although there was uncertainty about this coal tar
shampoo and vitamin D analogues used once daily. As with psoriasis trunk and limbs,
very potent steroids were the most effective treatment option.
Results
Considering comparisons between different active interventions, very few
demonstrated a statistically significant difference. Exceptions were that once daily and
very potent corticosteroids were significantly better than vitamin D regardless of
frequency of application.
One study for scalp and one for trunk and limb psoriasis suggested that the relapse
rate was greater for interventions containing steroids compared with vitamin D
analogues.
There was no statistically significant increased risk of steroid atrophy with
corticosteroid use compared with other interventions, although the majority of cases
of steroid atrophy reported did occur in people who received corticosteroids, and
greater numbers of withdrawals due to adverse effects were seen with twice-daily
potent corticosteroid compared with once-daily use.
Discussion
Overall, the NMA hierarchy of effectiveness for topical therapy for trunk and
limb psoriasis indicated that discounting very potent steroids, the
combination of potent corticosteroid and vitamin D analogue, either applied
once daily in a single TCF product or applied separately, was the most
effective intervention, with no significant difference between these
application methods.
The rank order of efficacy for the scalp almost similar. Very potent steroids
were the most effective treatment and vitamin D analogues and coal tar
shampoo were the least effective overall.
Discussion
Strengths of this study include the additional power afforded by
synthesizing all of the available data in one coherent network.
A recognized limitation of this analysis is that for the majority of trunk and
limb studies included, the severity of psoriasis was recorded as moderate to
severe.
Presence or absence of steroids atrophy was a key outcome in only a
minority of studies and no study used validated objective measures for
assessment.

- Thank You -