Proactive vs. reactive psoriasis therapy: a long-term evaluation with dermoscopic and confocal microscopy assessment

The PSO-LONG trial demonstrated that proactive management of psoriasis based on the regular application of the fixed-dose combination calcipotriol and betamethasone dipropionate (Cal/BD) foam twice a week for 52 weeks prolonged the time to first relapse and reduced the number of relapses, compared with the reactive management. Nevertheless, data about proactive management in clinical practice are still poor. This observational study compares the Cal/BD foam proactive management of psoriasis with the reactive scheme in consecutive patients with localized mild-to-moderate psoriasis. The degree of the skin atrophy was also assessed with dermoscopic and confocal microscopy analyses.

This retrospective observational study was conducted at the Federico II University Dermatological Clinic of Naples in adult patients treated with the fixed-dose combination Cal/BD foam (Enstilar®, Leo Pharma, Ballerup, Denmark) according to either a proactive or a reactive scheme (on-demand treatment). The observation time was 52 weeks.

149 patients were involved. The effectiveness of the proactive therapy was sustained by the significant reduction of the mean number of relapses (p=0.004) and by the significant increase of the median time to relapse (p=0.014) compared to the reactive regimen. Compared to the baseline values, significant improvements in the Psoriasis Area and Severity Index (PASI) score, Investigator Global Assessment (IGA) score, and Skindex-16 index were reported. Dermoscopy and confocal microscopy analyses showed the absence of cutaneous atrophy during the proactive treatment and improved the lesion's appearance.

The proactive regimen represents a valuable therapeutic novelty in treating mild-to-moderate psoriasis.