Therapy
Limited application of fluticasone propionate ointment, 0.005% in patients with psoriasis of the face and intertriginous areas,☆☆,,★★

https://doi.org/10.1067/mjd.2001.110046Get rights and content

Abstract

Background: Facial and intertriginous skin is more susceptible to corticosteroid-induced atrophy. Dosing regimens are needed for long-term management of corticosteroid-sensitive sites. Objective: The safety and efficacy of 0.005% fluticasone propionate ointment were assessed in the short-and long-term management of moderate to severe psoriasis of facial and intertriginous areas compared with nonfacial, nonintertriginous areas. Methods: Affected areas in 20 patients with psoriasis were treated twice daily for 2 weeks, then once daily for 2 consecutive days every week for 8 more weeks. Results: More than 50% improvement occurred after 2 weeks (day 15) in 100% of facial and intertriginous lesions and was maintained during long-term therapy in more than 85% of facial and intertriginous lesions. More than 50% improvement for nonfacial, nonintertriginous areas reached only 80% by day 15. Recurrence rates for facial and intertriginous areas were lower than in the nonfacial, nonintertriginous areas. Skin atrophy and telangiectasia did not occur. Facial and intertriginous sites responded more quickly to topical fluticasone propionate ointment than nonfacial, nonintertriginous skin. Conclusion: Limited application of fluticasone propionate ointment over a period of 10 weeks is effective and delays lesion recurrence without causing skin atrophy in patients with moderate to severe psoriasis in areas at risk for corticosteroid application, such as facial and intertriginous areas. (J Am Acad Dermatol 2001;44:77-82.)

Section snippets

Methods

This open-label study recruited adults with moderate to severe psoriasis (N = 20) involving the face or intertriginous areas and nonfacial, nonintertriginous areas. Patients were required to be at least 18 years of age and in good general health. Disease must have been present for at least 1 year and must have been stable or worsening for more than 1 week before the study. Lesions suitable for evaluating the response to treatment had to be present. Those excluded from enrollment included

Results

Twenty patients were enrolled into the study. Patient demographics are presented in Table I.

. Patient demographics

Characteristic(N = 20)
Age (y), mean (range)53 (28-79)
Ethnicity (%)
 Black10
 White60
 Hispanic30
Female/male (%)40/60
Total severity scores were rapidly and significantly improved by twice-daily treatment with topical fluticasone propionate ointment 0.005% (P < .001) (Fig. 1).

. Mean percent change in total severity scores of facial or intertriginous target lesions (♦) and of nonfacial,

Discussion

Few studies have examined the safety and efficacy of topical corticosteroids on facial and intertriginous skin, and even fewer data are available on long-term treatment of these sites. Therefore in chronic disease it is necessary to develop safe regimens in which improvement is achieved without incurring the side effects of cutaneous atrophy. In the present study, fluticasone propionate ointment 0.005% was applied twice daily for 2 weeks of acute treatment. This acute treatment phase was

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Supported in part by a grant from Glaxo Wellcome.

☆☆

*Dr Lebwohl has served as an investigator and consultant for Glaxo Wellcome.

Reprint requests: Mark G. Lebwohl, MD, The Mount Sinai School of Medicine, Department of Dermatology, One Gustave L. Levy Place, New York, NY 10029.

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J Am Acad Dermatol 2001;44:77-82.

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