Comparative efficacy of topical calcipotriol ointment with betamethasone valerate ointment in chronic plaque psoriasis

Background: Topical steroids are an established therapy for localized psoriasis. Calcipotriol (vitamin D₃ analogue) is a relatively newer addition to the therapeutic armamentarium of psoriasis. We compared the efficacy and safety of calcipotriol 0.005% ointment and betamethasone valerate 0.1% ointment in the treatment of chronic plaque psoriasis. Patients and methods: One hundred diagnosed cases of chronic plaque psoriasis, 50 patients in each group, were enrolled in the study. Age range was 20-55 years for calcipotriol group with a mean of 33.6 years and 15-52 years for betamethasone valerate group with a mean age of 32.6 years. Male to female ratio was 1.17:1 in calcipotriol and 2.13:1 in betamethasone group. Patients in both groups were advised to apply the topical agents twice daily for 6 weeks. They were followed up at 2, 4 and 6 weeks. The assessment was made on the basis of PASI. Overall response was graded as clearance (>70% reduction in PASI), marked improvement (60-70% reduction in PASI), mild improvement (50-60% reduction in PASI), no change and worsening. Results: The mean PASI reduction in calcipotriol group was from 6.33 at week 0 to 1.90 at week 6, whereas betamethasone valerate ointment group showed a decrease in mean PASI from 6.22 at week 0 to 2.26 at the end of treatment. The scores for erythema, infiltration and desquamation at each follow-up i.e. 2, 4 and 6 weeks were comparable in both groups. All the three parameters were effectively reduced by both the topical modalities during six weeks treatment period, but the difference was not significant statistically when compared with each other (p>0.05). Side effects were observed with both topical agents during 6 weeks of application. Most commonly observed side effects with calcipotriol were persistent lesional erythema in 10 (20%), lesional/ perilesional irritation in 7 (14%), pruritus in 4 (8%) and folliculitis in 2 (4%) of the patients. Adverse events noted with betamethasone valerate ointment were atrophy in 6 (12%), folliculitis in 5 (10%), persistent erythema in 4 (8%), pruritus in 2 (4%) and lesional irritation in 1 (2%) of the patients. Conclusion: Topical calcipotriol is as efficacious and safe as betamethasone valerate in the treatment of chronic plaque psoriasis.