Calcipotriol cream in the treatment of flexural psoriasis

In patients with psoriasis, 2-6% suffer from flexural psoriasis. Areas where flexural psoriasis is found are the axillae, groin, submammary region, perianal region, and retroauricular fold. Eleven patients with flexural psoriasis were enrolled in this study: six men and five women, aged between 5 and 55 years. All patients had common psoriasis presented with psoriatic lesions involving the axillae, groin and submammary region. Each patient was instructed to apply calcipotriol 50 microg/gm twice daily for 6 weeks. The treatment assessment, based on changes in erythema, scaling and thickness scores, was carried out at 2, 4 and 6 weeks. The overall assessment of our cases in this study showed a marked and significant improvement in the treated intertriginous areas. The mean scores of erythema, scaling and thickness before treatment were 2.7, 2.3 and 2.5, respectively. There was a marked and dramatic improvement in seven patients (63.6%) within the first 2 weeks in which the response was more significant than other nonintertriginous psoriatic lesions. At the end of treatment, 10 patients (91%) showed complete clearance, and the mean scores were reduced to 0. One patient showed only moderate improvement. No significant adverse effect was reported. In conclusion, calcipotriol cream is effective, safe and well tolerated in the treatment of flexural psoriasis. Because tar preparations and anthralin are irritants and potent steroids are absorbed more in these areas, calcipotriol cream could be a better choice for the treatment of these cases.