Treatment of scalp psoriasis with betamethasone dipropionate and calcipotriol two-compound product.

86 Letters to the Editor Sir, We read with interest the article of Dr Downs reporting the fast and good response of scalp psoriasis to a two-compound ointment containing 0.5 mg/g betamethasone dipropionate and 50 µ/g calcipotriol (Dovobet  ointment) (1). We report here the results of a 12-week open-labelled study that aimed to evaluate the efficacy and tolerabi-lity of treatment with Dovobet  ointment followed by a maintenance treatment with calcipotriol solution in scalp psoriasis. MATERIALS AND METHODS Twenty-five patients (17 men, 8 women; age range 20–74 years; mean age 45.5 years) entered the study, after giving written informed consent. They presented with scalp psoriasis alone or associated with stable localized lesions of plaque psoriasis that were adequately controlled by topical therapies. Patients were asked to avoid treatments that interfered with study evaluations (including medicated shampoos). Topical treatments for scalp psoriasis and standard systemic therapies were to be stopped for at least 2 and 4 weeks, respectively, prior to study entry. Study treatment consisted of three sequential phases: (i) application of Dovobet  ointment to the affected scalp areas once daily (qid) for 2 weeks; (ii) treatment with Dovobet  ointment qid and calcipotriol 0.005% solution twice daily on alternate days for 4 weeks; (iii) treatment with calcipotriol solution twice daily for 6 weeks. Patients were instructed to apply the two-compound ointment at bedtime and to wear a bathing cap overnight, shampooing their hair in the morning of the following day. Clinical evaluation was performed at baseline and after 2, 6 and 12 weeks. Signs of scalp psoriasis (erythema, scaliness, thickness) were scored using a 5-point scale (0 = absent; 1 = mild; 2 = moderate; 3 = severe; 4 = very severe). The same scale was used by patients for the assessment of severity of pruritus. Clinical total score corresponded to the sum of the single scores. Wilcoxon signed-rank sum test was used to compare clinical scores at week 2, week 6 and week 12 with baseline scores (statistical significance for p < 0.05). At week 12, patients assessed both the efficacy and cosmetic acceptability of the treatment regimen using a 4-point scale from poor to excellent. RESULTS All patients completed the study as scheduled. At baseline, mean total score was 8.3. A significant improvement of signs and symptoms was observed at week 2 (total score: 3.5), at week 6 (total score: 2.6) and week 12 (total score: …