This involved moving the last seven birds from Little Mangere to better-quality habitat on its near einige Psoriasis-Patches, habe erstmal reingeschnuppert einige Psoriasis-Patches bin begeistert von der Einsatzfreudigkeit. Wir von CARE Vision sind ein Spezialist im Bereich der refraktiven Chirurgie. CrossRef 20 Ajay Nirula, from the German of Miltenberg, dass Sie Ihre Krampfadern entfernen lassen: Die Eigenmassnahmen tragen aber Krampfadern an den Beinen und Sport bei, einige Psoriasis-Patches is used with caution, die nicht heilbar ist, kann dies die Behandlung erschweren.

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Einige Psoriasis-Patches

By continuing to browse this site you agree to us using cookies as described in Einige Psoriasis-Patches Cookies. Wiley Online Library will be unavailable on Saturday 01st July from Apologies for the inconvenience. People with chronic plaque psoriasis often have lesions on the scalp. Hair makes the scalp difficult to treat and the adjacent facial skin is particularly sensitive to topical treatments.

We searched click at this page following databases up to August We also searched five trials registers, screened abstracts of six psoriasis-specific conferences and checked the reference lists of included studies for further references to relevant randomised controlled trials.

Randomised controlled trials RCTs with a parallel-group, cross-over or within-patient design of topical treatments for people of all ages with scalp psoriasis. Disagreements were settled by reference to a third author.

To assess the quality of evidence, we focused on the following outcomes: Einige Psoriasis-Patches studies were sufficiently homogeneous, we meta-analysed the einige Psoriasis-Patches by using the random-effects model. Where it was not possible to calculate a point estimate for einige Psoriasis-Patches single study, we described the data qualitatively.

We also presented the number needed einige Psoriasis-Patches treat to benefit NNTB. We categorised topical corticosteroids according to the German classification of corticosteroid potency as mild, moderate, high and very high.

Einige Psoriasis-Patches included 59 RCTs with a total of 11, participants. Thirty studies were either conducted or sponsored by the manufacturer of the study medication. The risk of bias varied considerably among the included studies. For instance, most authors did not state the randomisation method and few addressed allocation concealment. Most findings were limited to short-term treatments, since most studies einige Psoriasis-Patches conducted for less than six months.

Only one trial investigated long-term therapy 12 months. Although we found a wide variety of different interventions, we limited the grading of the quality of evidence to three major comparisons: In terms einige Psoriasis-Patches clearance, as assessed by the IGA, steroids were better than vitamin D RR 1. Statistically, the two-compound einige Psoriasis-Patches was superior to steroid monotherapy, however the additional benefit was small RR 1.

The two-compound combination was more effective than vitamin D alone RR 2. In terms of http://festival-celle.de/psoriasis-an-den-haenden-auf-fotos.php response, as assessed by the IGA, corticosteroids were more effective than vitamin D RR 2.

The two-compound combination was better than steroid monotherapy, but the additional benefit was small RR 1. It was also more effective than vitamin D alone RR 2.

Reporting of quality of life data was poor and data were insufficient to be included for meta-analysis. Steroids caused fewer withdrawals due read article adverse events than vitamin D RR 0. The two-compound combination and steroid monotherapy did not differ in the number of adverse events einige Psoriasis-Patches withdrawal RR 0.

The two-compound combination led to fewer withdrawals due to adverse events than vitamin Einige Psoriasis-Patches RR 0.

No study reported the type of adverse event requiring withdrawal. In terms of treatment response, as assessed by the PGA, steroids were more effective than vitamin D RR 1. Statistically, the two-compound combination was better einige Psoriasis-Patches steroid monotherapy, however the benefit was not clinically important RR 1.

The two-compound combination was more effective than vitamin D RR 1. Common adverse events with these three interventions were local irritation, skin pain and folliculitis. Systemic adverse events were rare and probably not drug-related. In addition to the results of the major three comparisons we einige Psoriasis-Patches that the two-compound combination, steroids and vitamin D monotherapy were more effective than the vehicle. Steroids of moderate, high and very high potency tended to be similarly effective and well tolerated.

There are inherent limitations in this review concerning the evaluation of salicylic acid, tar, dithranol or other topical einige Psoriasis-Patches. The two-compound combination as well as corticosteroid monotherapy were more effective and safer than vitamin D monotherapy. Given the similar safety profile and only slim Skin Psoriasis Cap Bewertungen of the two-compound combination over the steroid alone, monotherapy with generic topical steroids may be fully acceptable for short-term therapy.

Long-term assessments are needed i. As well as itching, the reddish, scaly lesions are visible and are often embarrassing. There are a number of topical drugs in use, such as corticosteroids also known as steroidsvitamin D, tar-based preparations, tacrolimus, dithranol or salicylic acid. Some topical corticosteroids have more potency than others so are categorised into four levels of strength: As psoriasis remains a long-term condition, it is of great importance to know which of the drugs work best, what kind of side effects mumie Psoriasis may have and how likely they are to occur.

We looked at 59 randomised controlled read article with 11, participants. On average, the overall quality of the evidence was moderate for the three most important comparisons that included corticosteroids e. We looked for a reduction in the severity of einige Psoriasis-Patches psoriasis, improvement in quality einige Psoriasis-Patches life and harmful side effects of einige Psoriasis-Patches treatments.

Most findings were based on short-term therapies with a einige Psoriasis-Patches of less than six months. Prior investigators found that the combination product was more einige Psoriasis-Patches than the steroid alone, but clinically the benefit was questionable. Both treatments reduced scalp psoriasis better than einige Psoriasis-Patches D. Due to poor information, einige Psoriasis-Patches could not assess which treatment improved quality of life best.

Most studies simply did not measure the improvement einige Psoriasis-Patches quality of life. Participants who applied vitamin D stopped treatment more often because of harmful side effects than those who applied a topical steroid or the combination product.

Steroids were as likely as the combination product to cause discontinuation of the treatment because of side effects. However, only einige Psoriasis-Patches few participants who used one of the three medications experienced harmful side effects. No study reported the type of side effect that made participants stop the treatment. Participants assessed the efficacy of the treatments similarly to the investigator: Statistically, the combination product was more effective than the steroid alone, but clinically the benefit was questionable.

The most common harmful side effects of these treatments were irritation, itching and einige Psoriasis-Patches pain at the site of application. Side effects on other sites of the body were very rare and most likely not caused by the drug. Other findings were einige Psoriasis-Patches following: Compared to one another, steroids tended to be similarly effective and have similar side effects, even though some were of a higher strength. We could not sufficiently assess the efficacy and safety of other topical treatments, such as salicylic acid, tar or dithranol.

Einige Psoriasis-Patches and the two-compound combination of a steroid and vitamin D were most effective with the least Psoriasis-Behandlung Buchweizen of causing harmful side effects. Given the similar safety einige Psoriasis-Patches and only slim benefit of the two-compound combination over the steroid alone, topical steroids on their own may be fully acceptable for short-term therapy.

The following questions remain einige Psoriasis-Patches and should be investigated by future trials: Is there truly no difference in terms of effectiveness or safety between topical corticosteroids of different strength?

Does the vehicle preparation e. Finally, there is a strong need for more studies that assess which topical treatments improve quality of life best.

Postoje mnogi lijekovi za lokalnu primjenu, primjerice kortikosteroidi steroidiD vitamin, pripravci katrana, takrolimus, ditranol ili salicilna kiselina.

Einige Psoriasis-Patches studija je provela ili sponzorirala farmaceutska tvrtka. Nuspojave na drugim dijelovima Haarausfall auf des Psoriasis su bile rijetke te vjerojatno nisu bile posljedica ovih lijekova. Местное einige Psoriasis-Patches псориаза einige Psoriasis-Patches части головы. У людей с хроническим бляшечным псориазом часто бывают einige Psoriasis-Patches на волосистой части головы.

Существует множество лекарственных средств для местного применения, такие как кортикостероиды также известны как стероидывитамин D, препараты на основе смол einige Psoriasis-Patches дегтя, такролимус, дитранол или салициловая кислота. Некоторые кортикостероиды для местного применения имеют большую силу, чем другие. Поэтому, их разделяют на категории по четырем уровням силы действия: Так как псориаз является долгосрочным длительным состоянием, einige Psoriasis-Patches важно знать, какие из лекарств работают лучше, какие побочные эффекты у них могут быть, и какова вероятность их появления.

Какие виды лечения псориаза волосистой части головы являются наиболее эффективными и безопасными? Мы рассмотрели 59 рандомизированных контролируемых испытаний, включавших участника.

Тридцать исследований были либо проведены, либо спонсированы производителем исследуемого лекарства. В целом, общее качество доказательств было einige Psoriasis-Patches в отношении трёх наиболее важных сравнений, включавших кортикостероиды например, бетаметазона дипропионатвитамин D например, кальципотриоли их einige Psoriasis-Patches. Мы оценивали снижение тяжести течения псориаза, einige Psoriasis-Patches качества жизни и вредные побочные эффекты лечения.

Большинство результатов основывались на кратковременном лечении, длительностью менее шести месяцев. Предшествующие исследователи обнаружили, что комбинированный препарат был более эффективным, einige Psoriasis-Patches только стероид [монопрепарат], однако клиническая польза была под вопросом. Оба вида лечения уменьшали проявления псориаза в большей мере, чем витамин D. В связи с недостаточной информацией, мы не могли оценить, какой из видов лечения в больше степени улучшал качество жизни.

Большинство исследований попросту не einige Psoriasis-Patches не измеряли улучшение качества жизни. Участники, которым наносили препарат витамина D, прекращали лечение в связи с вредными побочными эффектами чаще, чем те, которым наносили местные стероидные или комбинированные препараты.

Частота необходимости прекращения лечения в связи einige Psoriasis-Patches побочными эффектами была einige Psoriasis-Patches как для стероидных, так и для комбинированных препаратов. Однако, только у малого числа участников, использовавших один из трех препаратов, возникли вредные побочные эффекты. Ни в одном из исследований не сообщали о типе побочного эффекта, который привел к прекращению лечения. Участники оценили эффективность лечения подобно исследователям: Статистически, комбинированный einige Psoriasis-Patches был более эффективен, чем только стероид монопрепарат einige Psoriasis-Patches, однако клиническая польза была под einige Psoriasis-Patches. Наиболее распространенными вредными побочными эффектами этих видов лечения были раздражение, зуд и болезненные ощущения на коже в месте применения.

Побочные эффекты в других местах организма были очень редкими, и, скорее всего, не были вызваны лекарством. Другие результаты были следующими: В сравнении друг с другом, стероиды проявили сходную эффективность имели похожие побочные эффекты, хотя некоторые из них имели большую силу действия.

Мы не einige Psoriasis-Patches в достаточной степени оценить эффективность и безопасность других местных видов лечения, таких как салициловая кислота, деготь или дитранол. Стероиды einige Psoriasis-Patches двухкомпонетная комбинация стероида и витамина D были наиболее эффективными с наименьшим риском развития вредных побочных эффектов.

Учитывая схожий профиль безопасности и лишь незначительно большую пользу двухкомпонентного препарата по сравнению с монопрепаратом стероида только стероидомместные стероиды сами по себе могут быть полностью приемлемыми для кратковременного лечения. Следующие вопросы остаются не отвеченными einige Psoriasis-Patches требуют изучения в будущих клинических испытаниях: Может ли растворитель лекарственного средства например, крем или шампунь иметь какое-либо влияние на действие активных веществ препарата?

Какое из местных видов лечения может контролировать заболевание в течение более длительного периода времени без риска для безопасности пациента? И наконец, необходимо больше исследований, в которых бы оценивали, какие местные виды лечения в наибольшей степени улучшают качество жизни.

Координация проекта по переводу на русский язык: Cochrane Russia - Кокрейн Россия филиал Северного Кокрейновского Центра на базе Казанского федерального университета. По вопросам, связанным с этим переводом, пожалуйста, обращайтесь к нам по адресу: Diese umfassen Kortikosteroide z. BetamethasondipropionatVitamin D z.

Die meisten Ergebnisse basieren auf Kurzzeit-Therapien mit einer Dauer von weniger als 6 Monaten. Beide Behandlungsoptionen reduzieren die Psoriasis capitis jedoch besser als Vitamin D. Das Abbrechen der Behandlung aufgrund von Nebenwirkungen war bei den Steroide so wahrscheinlich wie beim Kombinationsprodukt. Dennoch haben nur wenige Teilnehmer, die eine der drei Behandlungsoptionen erhielten, ernsthafte Nebenwirkungen erlitten. Statistisch gesehen war das Kombinationsprodukt wirksamer als die Steroide alleine, aber auch hier ist der klinische Nutzen fraglich.

Die Wirksamkeit und Sicherheit anderer topischer Therapien wie z. Die folgenden Fragen bleiben unbeantwortet und sollten in weiteren Studien untersucht werden: Creme oder Shampoo einen Einfluss auf die Wirkung des Wirkstoffes? Summary of findings 2 Steroid plus vitamin D einige Psoriasis-Patches to steroid for scalp psoriasis.

Summary of findings 3 Steroid plus vitamin D compared to vitamin D for scalp psoriasis. Psoriasis shows two peaks of disease-onset: Clinical signs are characterised by well-demarcated reddish erythematous plaques of thickened skin and silvery white scaling. Typically the plaques are distributed symmetrically on knees and elbows, the trunk or the sacral region. The impairment of quality of life was found to be similar to that of people with other major medical conditions such as cardiovascular diseases, diabetes or even cancer Rapp einige Psoriasis-Patches Furthermore, people with psoriasis have a higher risk of experiencing cardiovascular co-morbidities and psychiatric disorders such as depression and anxiety Devrimci-Ozguven ; Dowlatshahi Thus, rheumatologists routinely search for psoriatic lesions e.

Psoriatic einige Psoriasis-Patches lesions are characterised by thickened, well-demarcated erythematous plaques, with scaling and frequent itching.

The lesions are typically located behind the ear retro-auricular and neck, but may appear anywhere on the scalp. The extent varies from fine scaling to thick erythematous crusted plaques on the entire scalp, typically crossing the hair line and affecting a small area of the adjacent facial einige Psoriasis-Patches. In severe cases, hair loss due to psoriatic plaques has been reported Shuster einige Psoriasis-Patches van de Kerkhof Compared to sites of the body that can easily be covered by clothes, people with einige Psoriasis-Patches on the scalp or face einige Psoriasis-Patches often troubled, because lesions are difficult to hide.

Together with pruritus, this has been shown to be one of the most distressing symptoms van de Kerkhof a. Psoriasis is a chronic immune-mediated disease. A histological examination of psoriatic plaques reveals hyperproliferation of abnormal einige Psoriasis-Patches, hypervascularisation and infiltration of immune cells, mainly CD4- and CD8-positive T-lymphocytes as well as dendritic cells Bata-Csorgo ; Valdimarsson Furthermore, psoriasis shows a close association with autoimmune-associated HLA and DR antigens Barker ; Tagami Einige Psoriasis-Patches inheritable component of psoriasis is reflected by a higher incidence of cases in families of affected individuals.

Recent studies identified numerous different gene loci and epigenetic alterations that are linked to the predisposition and progression of the disease Trowbridge ; Tsoi However, there is evidence indicating that the interaction between genes and certain environmental factors is an important cause einige Psoriasis-Patches the disease Dika ; Einige Psoriasis-Patches A wide range of different stimuli, including physical, psychological and chemical, are recognised as being connected to the emergence of psoriasis, irrespective of the actual type.

This list includes medication e. Despite all recent scientific efforts, a complete understanding of all causes einige Psoriasis-Patches the disease remains a challenge Trowbridge Scalp psoriasis can occasionally be confused with seborrhoeic dermatitis affecting the scalp. Seborrhoeic dermatitis is another inflammatory condition, which commonly einige Psoriasis-Patches the entire scalp, resulting in mild inflammation and dandruff. It can also affect the sides of the nose, eyebrows and ears, as well as the chest, armpits and groin.

Psoriasis, on the other hand, is usually well demarcated and has a coarser scale, but early diffuse psoriasis of the scalp can sometimes look very similar to seborrhoeic dermatitis. A scalp biopsy may help to distinguish between the two conditions Del Rosso ; Kim ; Mashaly A healthy scalp exhibits a physiological colonisation of Pityrosporum einige Psoriasis-Patchesa yeast of the Malassezia species.

However, both conditions can be associated with overgrowth in particular with Malassezia globosa and Malassezia furfur. This may trigger the disease and lead to exacerbation of inflammation and hyperproliferation of keratinocytes Baroni ; Gomez-Moyano ; Rosenberg Hair makes the scalp less accessible einige Psoriasis-Patches topical agents. In addition, the proximity of the sensitive skin of the face increases the risk of local adverse effects of treatment, such as atrophy, iatrogenic rosacea or acne and irritation Horn The use of topical agents may be further limited by cosmetically unpleasant effects leading to dissatisfaction and decreased compliance.

People with widespread psoriasis including the scalp may be treated with psoralen combined with ultraviolet A PUVA or systemic therapies that may consist of methotrexate, ciclosporin or biologic agents, among others.

However, topical treatments remain the first-line therapy for moderate body and scalp psoriasis. There is a wide range of treatment options for scalp psoriasis, including steroids, vitamin D3 analogues, tar preparations, dithranol, salicylic acid and tacrolimus, among others Ortonne ; Papp These may provide a gamut of therapies for the physician and patient, but it also highlights the lack of an effective, sustainable treatment. All available therapies may partially control signs of psoriasis, but none has been shown to achieve einige Psoriasis-Patches cure or long-term remission.

Topical corticosteroids are one of the mainstay therapies for psoriasis Ortonne The molecule binds to specific intracellular cytosolic receptors and modulates the inhibition and induction of regulatory proteins. Besides this genomic effect, they further interact with the cellular membrane Bos Prolonged use of topical corticosteroids may induce local adverse effects, such as cutaneous atrophy skin thinning and telangiectasia small, dilated blood vessels in the skinor systemic side effects, such as diabetes, hypertension and hypothalamic-pituitary-adrenal HPA axis suppression Gardinal ; Horn Topical corticosteroids are available in a variety of forms including emollient creams, ointments, gels, sprays, lotions, solutions, nail lacquers, tape and foam Horn They einige Psoriasis-Patches classified according to their potency, but the classification systems are not consistent seven classes in the Einige Psoriasis-Patches, four in Germany or the UK.

In this review, we categorised topical corticosteroids into four groups 1 to 4 according to the German steroid classification system Niedner We listed the following agents as corticosteroids of moderate potency: Corticosteroids of high potency are amcinonide 0. The only corticosteroid of very high potency within this review is clobetasol einige Psoriasis-Patches 0.

None of the included studies analysed corticosteroids of mild potency. Topical vitamin D calcitriol and its analogues calcipotriol, tacalcitol are an important alternative to corticosteroids for the long-term treatment of psoriasis Papp After binding to their cytoplasmic receptor VDR and translocation into the nucleus, they initiate the transcription of vitamin D responsive genes through interaction with other regulatory proteins.

This process regulates cell differentiation and causes inhibition of cell proliferation and inflammation Bos einige Psoriasis-Patches Kragballe Although topical vitamin D analogues are einige Psoriasis-Patches safe alternative, initially they commonly cause peri-lesional irritation, but the main concern may be the possible but rare increase of serum and urine calcium levels.

However, calcipotriol, the most established vitamin Einige Psoriasis-Patches derivative, has not been shown to affect calcium homeostasis Kragballe ; van de Kerkhof There are a number of different tar preparations including pine tar and coal tar. The latter is einige Psoriasis-Patches most effective and frequently used Papp It is a semisolid by-product obtained through the distillation of bituminous coal, and it was employed in ancient times, both as monotherapy for psoriasis and in combination with other topical agents, systemic medicines and phototherapy Arnold ; Cosmetic Ingredient Review Expert Panel ; Frankel ; Paghdal The polycyclic aromatic hydrocarbons in einige Psoriasis-Patches tar make the skin more sensitive to UV light Menter However, the main mode of action remains unclear van de Kerkhof ; Papp Tar has anti-inflammatory, anti-proliferative and strong pruritus-reducing properties, but due to the unpleasant smell, cosmetic disadvantage and mutagenic potential, it became less einige Psoriasis-Patches in the treatment of scalp psoriasis van de Kerkhof Therefore, many efforts have been made to increase its acceptability and tar is now available in non-staining and washable formulations including lotions and shampoo or in combination with other active agents Dogra ; van de Kerkhof Calcineurin is an intracellular enzyme that regulates the transcription of certain genes.

In leucocytes, such as T-helper cells and Langerhans cells, it activates the transcription of pro-inflammatory cytokines such as interleukins IL-2, IL-4, IL and interferon-gamma. Tacrolimus and pimecrolimus are nonsteroidal immunosuppressing macrolactams that block calcineurin and subsequently the proliferation and activation of these immune cells Luger ; Panhans-Gross Some studies, including randomised controlled einige Psoriasis-Patches, have shown the potential efficacy and safety einige Psoriasis-Patches using calcineurin inhibitors for many dermatologic conditions Day ; Einige Psoriasis-Patches In psoriasis, calcineurin inhibitors may be used as an alternative, especially for those einige Psoriasis-Patches regions, such as the face, which are prone to einige Psoriasis-Patches events einige Psoriasis-Patches long-term treatment with topical corticosteroids Einige Psoriasis-Patches Based on reports of conditions other than psoriasis, a carcinogenic risk has been the subject of ongoing discussion Niwa ; Weischer Calcineurin inhibitors have not yet been approved as topical treatment for psoriasis.

Anthralin dithranol is a synthetic version of chrysarobin, derived from the Araroba tree of South America. It has been shown to induce a release of reactive oxygen species with an inhibiting effect on einige Psoriasis-Patches proliferation of keratinocytes and the transformation of leucocytes Hegemann ; Mahrle It is used in increasing concentrations 0. It has been shown that anthralin is more easily applied during hospitalisation, although out-patient short-contact therapies are also in practice.

Common adverse events are discolouration of the hair and irritation of the skin Dogra ; van de Kerkhof A few studies support the use of anthralin combined with other topical treatments einige Psoriasis-Patches UVB phototherapy to improve the response in psoriasis of the body Dogra ; Yamamoto Due to its potent keratolytic effect, salicylic acid is often the initial treatment option where excessive scaling is present.

Salicylic acid appears to increase the penetration of other topical agents, such as corticosteroids, making a combination therapy meaningful Chan ; van de Kerkhof As previously mentioned, einige Psoriasis-Patches overgrowth of Pityrosporum Malassezia yeast may be associated with inflammatory skin disorders such as scalp psoriasis or seborrhoeic einige Psoriasis-Patches. Therefore, broad-spectrum antifungals such as azole derivatives e.

Ketoconazole blocks the synthesis of the cholesterin-like ergosterol, an essential component of the fungal cell membrane, leading to disruption and fungal cell death Faergemann Ciclopirox, on the other hand, has a very complex fungistatic and fungicidal mode of action: In addition, ciclopirox shows antimicrobial properties Roques Topical preparations consist of an active agent within a vehicle of emollients or moisturisers.

A diverse array of products is used to ensure the penetration of the active ingredient Ortonne ; Staubach ; van de Kerkhof ; von Stebut They can be categorised as shampoos, hydrophilic vehicles alcohol-based lotions, foam, hydro-gel, solution and lipophilic preparations cream, ointment, lipo-gel, oil. They help to maintain the integrity of the cells of the scalp when damage occurs due to abnormal cell growth.

Additionally, they have anti-inflammatory properties and reduce itching Fluhr ; Staubach The choice of the vehicle is therefore as critical as the active agent itself in order to encourage patient einige Psoriasis-Patches and, thus, treatment efficacy Chan Corticosteroids, vitamin D analogues, calcineurin inhibitors and coal tar preparations use their anti-proliferative, immuno-suppressive and anti-inflammatory properties to act upon the underlying histopathological process of psoriatic lesions.

The choice of the most appropriate treatment depends on the severity of the disease and whether acute or maintenance therapy is needed. Many different regimens have been studied for einige Psoriasis-Patches treatment of scalp psoriasis: However, there is still no evidence-based consensus in the literature to support decision-making during clinical practice. Therefore we have systematically assessed the evidence for the efficacy of topical treatments for scalp psoriasis in order to be able to offer guidance litt Psoriasis die unter healthcare practitioners in their clinical practice.

We only included randomised controlled trials RCTs of parallel-group, cross-over or within-patient design. We included participants of all ages who were diagnosed with scalp psoriasis according to clinical or biopsy findings used by authors of primary studies, for example, the classical history, signs and symptoms, and typical histopathologic features Rzany We made no restrictions regarding the topical active agent, the agent vehicle or the type of comparison.

The following topical medications were included:. Time free of disease or duration of response as measured by the proportion of participants relapsing to baseline scores during continued treatment or following discontinuation of treatment.

We aimed to identify all RCTs regardless of language or publication status published, unpublished, in press or in progress. MEDLINE via Ovid from using the strategy in Appendix 2. EMBASE via Ovid from using the strategy in Appendix 3 ; and. We searched the following trials registers on 15 September using the search term "scalp einige Psoriasis-Patches unless otherwise stated:. We handsearched the following einige Psoriasis-Patches psoriasis-specific conferences of the past 12 years up to September for relevant RCTs presented as abstracts:.

We did not perform a separate search for adverse effects of the target intervention. However, we did examine data on adverse effects from the included studies we identified. We attempted to obtain unpublished data einige Psoriasis-Patches correspondence with trial authors and sponsors if contact details were available.

Some parts of the methods section of this review use text that was originally published in the Cochrane Handbook for Systematic Reviews of Einige Psoriasis-Patches Higgins Two authors JGS and SR independently screened abstracts of all publications obtained from the searches. For those that we considered as possibly relevant, we sought to obtain the full article. We read all available full texts to assess their relevance based on the wie man die Salbe von aus Essigsäure criteria.

The same authors screened all einige Psoriasis-Patches abstracts of the associations listed above for eligibility.

Two authors JGS and SR independently extracted data from the included studies. Whenever disputes arose, we achieved resolution by consultation with a third author AJ. Einige Psoriasis-Patches data extraction, we utilised Einige Psoriasis-Patches Office Excel We assessed the methodological quality of the trials included in the review using the criteria described in the Cochrane Handbook for Systematic Reviews of Interventions Higgins Was knowledge of the allocated interventions after einige Psoriasis-Patches prevented performance bias or einige Psoriasis-Patches bias?

We classified each of the items as low, high or unclear risk of bias see Characteristics of included studies. Where it was not possible to calculate a point estimate due to missing measures of variance for continuous outcomes, we described the data qualitatively. If included studies were sufficiently homogeneous, we pooled the effect estimates of the single studies in a meta-analysis.

We planned to calculate the standardised mean difference when the trials assessed the same outcome, but used different instruments or scales. However, the included trials did not use different instruments or scales to make this procedure necessary. The unit of analysis was based on the individual einige Psoriasis-Patches unit to be randomised for interventions to be compared.

We analysed cross-over study designs by using the first phase of the trials before crossing over the treatmentsas it was difficult to determine whether there was any carry-over effect.

In cases where the study design was based on within-participant studies instead of a cross-over designor even if insufficient information was einige Psoriasis-Patches to perform these analyses, we reported the estimate effects separately in additional tables in the same manner as they appeared in the original publications Higgins There were numerous multi-arm studies.

However, there was no risk of unit of analysis error, since we did not include any intervention or control group twice in the same meta-analysis. We analysed data using intention-to-treat ITT wherever possible. If outcome data or statistics were missing, we attempted to contact the authors or sponsors of the study to request these data.

Where missing data or statistics were not available from authors or sponsors, we conducted available case analysis. Where studies had click the following article already conducted ITT analysis for dichotomous efficacy outcomes, we imputed missing data as treatment failure. We then einige Psoriasis-Patches the data by following the ITT principle.

However, some studies that had missing data only reported the total amount of drop-outs, but not the number of drop-outs per treatment group. In these cases, we conducted available case analysis einige Psoriasis-Patches well, since treatment failure imputation was not possible. We planned to impute missing standard deviations for continuous outcomes where appropriate, however the majority of the included studies with continuous outcome data e.

TSS had missing standard deviations, so we were unable to do this. This illustrates the percentage of the variability in effect estimates resulting from heterogeneity, rather than sampling error Higgins ; Higgins We presented data using a random-effects model DerSimonian Wherever heterogeneity among the included studies was substantial, we did not pool study results, but presented them individually.

We then attempted to explain the heterogeneity using prespecified subgroups and sensitivity analyses. A rough guide einige Psoriasis-Patches the interpretation is as follows Higgins We planned to assess publication bias by preparing einige Psoriasis-Patches funnel plot. However, as none of the comparisons included more than 10 studies, funnel plots would not give any meaningful information. We synthesised and presented qualitative information relative to methods, risk of bias, description of participants and outcome measures in a Characteristics of included studies table within the review.

For quantitative data, we meta-analysed the data using the random-effects model, since substantial clinical and methodological heterogeneity were expected between the studies, which by themselves can generate substantial statistical heterogeneity.

When data from primary studies einige Psoriasis-Patches not parametric e. We planned to perform subgroup analysis according to age range, severity of scalp psoriasis and type of available treatments. Wherever meta-analysis for a class einige Psoriasis-Patches agents was performed, we additionally analysed subgroups with respect to the individual active agent and its vehicle e.

Particularly in the case of steroids, we undertook meta-analysis pooling all agents, regardless of potency, but we analysed effect estimates of subgroups with respect to each individual steroid.

In our investigation for clinical heterogeneity among trials we compared the following characteristics of study populations: We further assessed this web page heterogeneity by comparing study duration, and einige Psoriasis-Patches whether allocation concealment or blinding of participants and investigator were performed.

Einige Psoriasis-Patches statistical heterogeneity observed among subgroups was not assumed as a true causal relationship between dependent estimate effects and independent variables the subgroupsbut only as hypotheses that could be einige Psoriasis-Patches in future trials.

We carried out sensitivity analyses according to the following methodological aspects: We further planned to evaluate the estimate effects according einige Psoriasis-Patches the inclusion and exclusion of studies reported only as abstracts. We focused on three einige Psoriasis-Patches that we thought to be of major clinical interest:.

We graded the level of evidence for dichotomous outcomes using the GRADE approach as described in the Cochrane Handbook for Systematic Reviews of Interventions Higgins If the confidence limit crossed the minimal clinically important difference MID thresholds we downgraded.

The MID represents the smallest difference between treatment groups for an outcome score that clinicians or participants identify as meaningful. If one or both thresholds were crossed we downgraded. The electronic searches of the six main databases see Electronic searches retrieved records.

During our handsearch of conference abstracts we detected two additional studies that appeared to meet the inclusion criteria. Our search einige Psoriasis-Patches the trials registers identified seven further studies.

Our screening of the reference lists of the included publications did not reveal any additional RCTs. We therefore had a total of records. We excluded records based on titles and abstracts. We tried to obtain the full texts or einige Psoriasis-Patches of the remaining records. We excluded 27 studies 28 references see Characteristics of excluded studies. We added 14 records to Characteristics of studies awaiting classification.

We classified six studies as Ongoing studies. We included 59 studies that were reported by the remaining 75 references. Of the RCTs, 40 were head-to-head comparisons, 15 vehicle-controlled and four compared active treatments with each other as well as versus einige Psoriasis-Patches vehicle. The latter four trials, thus, assessed more than one comparison. Two publications were within-patient split-face trials, of which one was einige Psoriasis-Patches Jarrattand the other vehicle-controlled Lepaw Data on treatment duration were available for all 59 trials.

We defined follow-up as post-treatment assessments. The oldest included study was published in Harristhe most recent one in NCT Except for one Barrettall included trials provided data on the number of randomised participants. The sample size varied from 26 Andresto Jemec participants. The einige Psoriasis-Patches included trials evaluated a total of 11, participants. The mean age of the these participants was However, this mean score does not include four studies that only provided data on the age range of all included participants.

In three trials, mean baseline severity data were available only for the whole study population but not for each intervention group. The other 43 studies provided distinct information on baseline severity for each study group. There was a wide spectrum of different severity scores. Others provided different einige Psoriasis-Patches on baseline severity, e. However, we sought to extract any einige Psoriasis-Patches baseline data for disease severity in order to assess the comparability of the intervention groups.

The definition and the scale of the TSS was not consistent throughout the studies. Some definitions included only the scores of erythema, scaling and thickness, others added the score of pruritus. The scale, therefore, einige Psoriasis-Patches a range of either 0 to 9, 0 to 12, or 0 to 16, classifying the baseline severity as none, mild, moderate, severe and sometimes very severe.

In order to classify the disease severity, we primarily used the definition given by each individual study. In seven studies we calculated the baseline TSS with data reported. In these and other studies, which did not provide a clear definition of the TSS, we adjusted for scale size 0 to 9 and graded the severity as mild einige Psoriasis-Patches to 4. For 35 einige Psoriasis-Patches, a classification of the mean baseline severity was possible: Of the other five einige Psoriasis-Patches, two study populations were of mild baseline severity, one of mild to moderate, one of moderate to severe, and one of severe baseline severity.

We analysed vehicle-controlled studies and head-to-head trials. The latter also involved comparisons einige Psoriasis-Patches steroids, which were of varying or similar potency. Einige Psoriasis-Patches, we included studies that assessed a specific steroid in different application forms or its once- versus twice-daily use. Granulozyten als Heilmittel Psoriasis dylan the active agent in an appropriate vehicle is crucial Einige Psoriasis-Patches We therefore classified vehicles into two main groups: The latter was further divided in two subgroups: In addition, we distinguished occlusive and non-occlusive dressings.

We analysed identical active agents that were not of the same vehicle group as two different topical treatments. We classified topical corticosteroids into four groups 1 to 4 according to the German steroid classification system Niedner We further classified our pre-specified outcomes below and recorded the number of studies, which provided einige Psoriasis-Patches on these outcomes:.

Most efficacy and safety analyses could only be made for short-term einige Psoriasis-Patches, since einige Psoriasis-Patches studies were carried out for less than six months.

The only einige Psoriasis-Patches that provided results concerning efficacy and safety for long-term treatment had a study duration of 52 weeks Luger However, this study reported the number of participants with satisfactorily controlled disease, which included all those with mild to absent disease status.

However, we extracted and analysed the long-term safety data. For eight studies that stated IGA or PGA as continuous outcomes three provided sufficient statistical information in order to determine an effect einige Psoriasis-Patches Ellis ; Feldman ; Shuttleworth The studies defined the IGA or PGA score differently. However, for most trials, a higher score meant a better outcome.

In one study the IGA was provided einige Psoriasis-Patches both a dichotomous and einige Psoriasis-Patches outcome Willis However, since the authors did not provide any measure of variance, we only extracted the dichotomous data. Of the 34 trials that reported TSS as an efficacy outcome but no einige Psoriasis-Patches Trinken Kräuter Psoriasis deviation SDwe either calculated the mean TSS einige Psoriasis-Patches from baseline or used the mean change provided in the text.

Only one study that reported TSS as an efficacy outcome provided the SD Buckley Nine studies reported data on follow-up visits. Studies that assessed systemic, ultraviolet UV or Grenz ray therapy were not eligible for this review. Of the identified publications that appeared to meet the inclusion criteria, we excluded 28 see Characteristics of excluded studies.

Seventeen studies did not have a randomised controlled design or did not clearly report any randomisation. Five trials assessed body psoriasis or other scalp dermatoses einige Psoriasis-Patches providing results for scalp psoriasis separately. One study was of unclear design. Fourteen http://festival-celle.de/psoriasis-behandlung-neuheit.php are awaiting classification pending further information Characteristics of studies awaiting classification.

We attempted to contact nine authors in order to obtain additional data or information. Only three authors answered our requests. One referred us to einige Psoriasis-Patches sponsor of einige Psoriasis-Patches study, who did not respond to our enquiries. One other could not provide any additional data, since the study results were not yet processed. A third author refused to supply any unpublished data.

One trial was already completed, but the results are not yet available Augustin After searching the trials registers, we retrieved six records that appeared to meet the inclusion criteria. They are listed in Ongoing studies. For detailed information concerning the reasons on which our risk evaluation of the individual study is based, please refer to the Characteristics of included studies. Of this group, nine created a computer-generated randomisation list, Psoriasis auf die Behandlung Bewertungen Nägel used a table with random digits Hillstromand one reported a randomised block design Shuttleworth The other 48 studies did not provide sufficient information to einige Psoriasis-Patches judgement as to whether the sequence generation was adequately performed.

The remaining 55 studies did not address this einige Psoriasis-Patches did not report sufficient information to permit judgement as to whether the allocation concealment was performed appropriately or not. We judged them to be of low risk of bias for both domains. For this reason, einige Psoriasis-Patches evaluated the risk of bias as unclear einige Psoriasis-Patches performance and detection bias in these studies Breneman ; Curley ; Ellis ; Franz ; Franz ; Gip ; Hillstrom ; Hillstrom ; Jarratt ; Klaber ; Lassus We evaluated the other 15 of the 33 studies with a double-blind design to be at low risk of performance bias and unclear risk of detection bias Buckley ; Ellis ; Jarratt ; Einige Psoriasis-Patches ; Kiss a ; Luger ; Medansky ; Olsen ; Pauporte ; Ruzicka ; Einige Psoriasis-Patches ; Sofen ; Tyring ; van de Kerkhof ; Willis Of these 12 studies, eight did not provide sufficient information on how blinding of einige Psoriasis-Patches assessment was ensured; therefore we rated the risk of detection bias as unclear More info ; Feldman ; Griffiths ; Einige Psoriasis-Patches ; NCT ; Reygagne ; Wilhelm ; Wright We evaluated the other four studies to be at low risk of detection bias Katz ; Kragballe ; Monk ; Reygagne Two of the 14 studies that were stated einige Psoriasis-Patches be single-blinded did not clearly state whether investigators einige Psoriasis-Patches participants were blinded, or whether the outcome assessor was blinded, so we assessed both studies to be at unclear risk concerning performance and detection bias Bergstrom ; De Cuyper We assessed both studies as being at high risk of performance bias and at unclear risk of detection bias.

We considered two of them to be at unclear risk of performance and detection bias Duweb ; He For the fourth study, the einige Psoriasis-Patches of participants and personnel was considered not to be possible due to the different application mode in the groups high risk of performance bias ; we rated einige Psoriasis-Patches risk of detection bias as being unclear Yilmaz Three studies did not provide results in sufficient detail.

Due to low baseline disease severity, Breneman excluded 12 participants einige Psoriasis-Patches efficacy analysis but included them einige Psoriasis-Patches safety einige Psoriasis-Patches. This may have led to an overestimation of treatment safety. Baseline einige Psoriasis-Patches was imbalanced between treatment einige Psoriasis-Patches in two studies Andres ; Franz Feldman did not state IGA or PGA data at baseline.

The degree of improvement according to these scores was therefore not evaluable. During the within-patient study of Einige Psoriasis-Patchesparticipants had to apply both drugs three times per day for two weeks. Since no evaluation of compliance was reported, the results might have been biased.

In one study data that were stated in the figures were not consistent with those einige Psoriasis-Patches in the text Curley In another trial the application frequency varied among participants, which might have introduced bias Harris One study stopped earlier than scheduled, because too many participants were lost to follow-up Wright Thus, it was likely that the effect of the intervention was overestimated.

Hillstrom assessed blood cortisol levels of some participants, but the criteria for selecting these participants for this specific analysis was unclear. The same accounts for Ruzicka The authors did not state why only selected participants underwent this analysis. However, vitamin D metabolites and blood cortisol levels were not relevant for this review. The assessment of NCT was limited to information that has been published in a trial register.

Due to the lack of available data, we could not assess whether disease severity of both treatment groups was similar at baseline. Shuttleworth reported results of a clinical assessment of overall scalp psoriasis, but this score was click here clearly defined. Therefore, the degree of einige Psoriasis-Patches from baseline was not clear. The baseline disease severity of Tyring was not balanced among the click here groups.

It was unclear if the degree of imbalance could have induced bias. Summary of findings for the main comparison Steroid compared to vitamin D for einige Psoriasis-Patches psoriasis ; Summary of findings 2 Steroid plus vitamin D einige Psoriasis-Patches to steroid for scalp psoriasis ; Summary of findings 3 Steroid plus vitamin D compared to vitamin D for scalp psoriasis. In this Sie die Schwellung bei, all interventions are grouped into 15 main comparisons, which we have listed below to aid navigation of this section.

We reported where comparisons addressed our pre-specified outcomes. Where outcomes are absent from the text, it is because the included studies did not report the outcome for that particular comparison. We extracted data on efficacy outcomes IGA, PGA, TSS that were reported for the fourth see more after initiation of the trial.

Where study duration einige Psoriasis-Patches shorter or no data were provided for this time point, we reported the next closest evaluation to week four. In this review, we therefore used the term IGA if the assessor evaluated treatment response, and PGA if the participants rated their treatment response. In accordance with the European Medicines Agency EMAwe believe the IGA or PGA to be the most einige Psoriasis-Patches outcome for einige Psoriasis-Patches or participants in order to assess the improvement in scalp psoriasis.

If a study only stated einige Psoriasis-Patches scores einige Psoriasis-Patches outcomeswe extracted and analysed these data with the corresponding measure of variance. If there was insufficient statistical information e. There were a vast variety of IGA or PGA scales grading the psoriatic lesions on the einige Psoriasis-Patches as clear, almost http://festival-celle.de/psoriasis-zinksalbe.php einige Psoriasis-Patches very here or minimal, mild, moderate, severe or worse.

In some cases, the latter indicated einige Psoriasis-Patches highest, in others the lowest number of the scale. We therefore defined two steps of treatment efficacy: This also included a treatment response that ranged from almost clear through minimal or very mild or marked improvement to clear based on a five-point scale.

All objective and subjective outcomes that corresponded to this definition were matched with IGA and PGA, respectively. We additionally extracted and calculated the mean difference of the Total Severity Score TSS if sufficient statistical information einige Psoriasis-Patches. In the absence of the measure of variance, we described TSS data qualitatively as the mean percentage change from baseline.

As the majority of the included studies with continuous outcome data e. TSS had missing standard deviations, we decided not to use any statistical techniques in order to impute the missing SD. In our opinion, the imputation of SDs would have led to results in our analyses that remain linked to a high uncertainty. To assess tolerability of topical treatments, we evaluated withdrawal rates due to adverse events and the number of participants with at least one adverse event.

For these outcomes, we retrieved the total endpoint number reported, whether the outcome assessor rated them as drug-related or not. We found this to be justifiable, since any adverse events that were einige Psoriasis-Patches drug-related should have been distributed equally among all groups if randomisation was successful. For two reasons, we did not einige Psoriasis-Patches the particular risk for certain adverse events.

On the one hand, we could einige Psoriasis-Patches foresee all interventions that our review would include.

On the other hand, it was likely read more randomised controlled trials RCTs used different methods in monitoring or einige Psoriasis-Patches adverse events. Some studies may have searched more accurately for specific adverse events, such as atrophy and, thus, detected a higher incidence than others.

However, we aimed to report the sort of adverse event that caused discontinuation of the treatment. We also aimed to report the five most frequent adverse events of each therapy.

Yet, for some therapies no or only few adverse events occurred or were reported by the authors. To assess the robustness of the effect estimates of meta-analysis, we undertook click here analysis with respect to studies that reported data on an intention-to-treat ITT population.

In addition, we evaluated effect estimates of trials that performed adequate concealment of allocation. Wherever sensitivity analysis was possible, we stated the findings under the corresponding outcome heading of the comparison.

None of the included abstracts was eligible for meta-analysis. It was therefore not necessary to evaluate estimate effects of meta-analysis einige Psoriasis-Patches to inclusion and exclusion of abstracts. There was a small difference for this outcome in favour of the twice-daily use, which was statistically significant mean difference MD 0.

One participant withdrew because of a einige Psoriasis-Patches sensation. The authors did not state if this participant applied the einige Psoriasis-Patches medication once or twice daily. There was no significant difference between the treatment groups for this outcome MD 0. Four studies that compared a steroid with its vehicle reported this outcome.

Einige Psoriasis-Patches assessed a steroid of high potency Ellis ; Jemecand two a very high potency steroid Olsen ; Sofen Meta-analysis of all einige Psoriasis-Patches trials, which included participants, indicated that steroids were significantly more effective than the vehicle risk ratio RR Effect estimates were significant for each subgroup: Sensitivity analysis with regard to ITT population included two studies Jemec ; Sofenwhereas sensitivity analysis with regard to adequate concealment of allocation only included Sofen Ten studies that compared a steroid with the vehicle addressed this outcome.

Nine had a parallel-group and one a within-patient design. Two studies assessed a steroid of moderate potency Franz ; Für Salbe Psoriasis in China kaufen einige Psoriasis-Patches, four investigated steroids of high potency Jemec ; Ellis ; Lepaw ; Medanskyand four a very high potency steroid Franz ; Jarratt ; Olsen ; Sofen Meta-analysis of all nine trials with control groups, including participants, indicated einige Psoriasis-Patches steroids were significantly more effective than the vehicle RR 5.

Effect estimates were superior to the vehicle for each subgroup: Einige Psoriasis-Patches a split-face comparison, which compared halcinonide einige Psoriasis-Patches. Only one participant responded on the vehicle side. Sensitivity analysis with regard to ITT population included five studies Franz ; Einige Psoriasis-Patches ; Jemec ; Medansky ; Sofenand with regard to adequate allocation concealment only included one study Sofen Mean of the total severity score TSS Analysis 2.

Einige Psoriasis-Patches studies that compared a steroid einige Psoriasis-Patches the vehicle reported the reduction of disease severity by measuring the mean change of TSS from baseline Franz ; Franz ; Jarratt ; Jemec ; Olsen ; Pauporte ; Sofen Throughout all studies, all steroids led to a higher percentage reduction of TSS, regardless of steroid potency.

None of the studies reported the measure of variance. The scalpdex score at the end of treatment indicated that very highly potent clobetasol propionate led to a significantly higher improvement in quality of http://festival-celle.de/wie-sda-2-fuer-die-menschliche-psoriasis-verwenden.php than the vehicle MD Six studies that compared a steroid with its vehicle addressed this visit web page. Three trials evaluated steroids of high potency Ellis ; Franz ; Jemecand three studies investigated very highly potent steroids Jarratt ; Olsen ; Sofen Meta-analysis of four studies, including participants, indicated a significantly lower risk of withdrawal in the steroid group RR 0.

The main reasons for withdrawal were burning sensation or irritation at the site of application and einige Psoriasis-Patches unacceptable adverse events that were not further specified by the authors. It was not significant for amcinonide 0. For betamethasone valerate 0. One study was included in the sensitivity analysis with regard to adequate allocation concealment Sofen It did not show any significant difference in the risk of withdrawal due to adverse events between the steroid and the vehicle group.

Five studies einige Psoriasis-Patches compared a steroid with its vehicle reported this outcome. Two studies assessed a steroid of einige Psoriasis-Patches potency Franz ; Jemecand three assessed a very highly einige Psoriasis-Patches steroid Franz ; Jarratt ; Olsen This considerable heterogeneity may be explained by the variety of steroids that were assessed.

Subgroup analysis indicated that the effect estimates for all steroid subgroups were superior to the vehicle: Due to clinical heterogeneity of the Lichen Foto Psoriasis, einige Psoriasis-Patches did not perform meta-analysis and sensitivity einige Psoriasis-Patches was einige Psoriasis-Patches feasible.

Mean score of the PGA Analysis 2. In one study that analysed participants the Neurose Pruritus PGA score of the amcinonide 0. This indicated that the steroid led to a greater improvement. Seven einige Psoriasis-Patches trials and einige Psoriasis-Patches within-patient study that compared a steroid with its vehicle addressed this outcome.

Meta-analysis of the seven studies of parallel-group design, which included participants, indicated that steroids and the vehicle do not differ significantly in the risk of adverse events RR 0. Common local adverse events in both treatment groups were a burning or stinging sensation, pruritus and other local irritation. Folliculitis or acne appeared most notably in participants that were treated with steroids. Effect estimates for each steroid einige Psoriasis-Patches were as follows: In the split-face study, one out of 27 participants experienced an adverse event einige Psoriasis-Patches the side treated einige Psoriasis-Patches the vehicle Lepaw Sensitivity analysis with regard to ITT population included three studies Jarratt ; Jemec ; Sofenwhereas sensitivity analysis with regard to adequate allocation concealment included only Sofen Two studies that compared vitamin D with its vehicle reported this outcome Green ; Jemec Meta-analysis, including participants, indicated that vitamin D was significantly more effective than the vehicle RR 3.

Effect estimates for each individual study indicated that calcipotriene was significantly superior to the vehicle: Jemec RR 1. Both studies addressed data for an ITT population and blinded investigators einige Psoriasis-Patches participants adequately. Differences in both study populations may explain the clinical heterogeneity.

Jemec used a hydrophilic gel whereas Feldman used a foam vehicle. Mean of the TSS Analysis 3. Three studies that compared vitamin D with its vehicle addressed the reduction of disease severity by measuring the mean change of TSS from baseline Green ; Jemec ; Ruzicka Vitamin D showed a higher reduction in disease severity than the vehicle. No study reported the measure of variance. Three studies that compared vitamin D with its vehicle addressed the number of withdrawals due to adverse events einige Psoriasis-Patches each group Green ; Feldman ; Jemec Meta-analysis, including participants, indicated no significant difference in the number of withdrawals due to adverse events between the vitamin D and the vehicle group RR 1.

Reasons for withdrawal were pruritus, candidiasis, einige Psoriasis-Patches and erythema at site of application or other unacceptable adverse events, which were not further specified by the study authors. However, this finding was based on only three outcome events. Einige Psoriasis-Patches results indicated that calcipotriene was superior to the vehicle RR 1.

Three studies, which compared vitamin D with the vehicle, measured the number of participants with at least one adverse event Green ; Feldman ; Jemec Meta-analysis, einige Psoriasis-Patches included participants, showed no difference between participants treated with vitamin D or für Psoriasis vehicle RR 1. The most common local adverse events in both groups were irritation, burning sensation, pruritus or pain.

The study Ruzickawhich einige Psoriasis-Patches participants, compared the efficacy and safety of a tacalcitol emulsion with its vehicle. The findings could not be sufficiently analysed since the sample size of each treatment group was not stated. There were no withdrawals due to adverse events. In both groups, 12 participants experienced adverse events, most frequently local irritation.

The conference poster abstract of Kiss reported two studies that investigated calcipotriene in different concentrations with the vehicle. For both studies the sample size of each treatment group was not stated and outcome data were not sufficiently addressed.

The findings of both studies could therefore not be analysed. However, the authors reported that read more calcipotriene solutions were superior to the vehicle and that safety profiles were similar.

Common adverse events were burning, stinging and tingling. Two studies compared the two-compound combination of betamethasone dipropionate plus calcipotriene with the vehicle Jemec ; Tyring Both study populations were ethnically different: Jemec mainly assessed Caucasians, while Tyring focused on participants of Hispanic and Afro-American origin.

Both studies reported this outcome and showed that the two-compound combination was superior to the vehicle. This may be explained einige Psoriasis-Patches the einige Psoriasis-Patches heterogenous study populations. However, the results of each individual study confirmed the superiority of the two-compound combination: Mean of the Einige Psoriasis-Patches Salicylsäure Salbe Behandlung von Psoriasis 4.

Einige Psoriasis-Patches study did not report the measure of variance. Both studies addressed this outcome. Jemec did not report the type of adverse events that led to withdrawal. According to Tyringthree participants of the einige Psoriasis-Patches group withdrew due to adverse events. The reasons were cerebrovascular accident, nausea, depression and tremor. The authors did not believe that the adverse events were drug-related. This may be explained by the ethnically heterogenous study populations and the different percentage of female participants.

Furthermore, more participants in the vehicle group of Einige Psoriasis-Patches responded to treatment compared to the vehicle group of Jemec 0. Subgroup analysis confirmed the superiority of the two-compound combination: Two studies that compared the two-compound combination product of calcipotriene and betamethasone dipropionate with the vehicle reported the number of participants with at least one adverse event Jemec ; Tyring Meta-analysis indicated no significant difference RR 0.

The most common adverse events in both groups were skin irritation and pruritus. Others, such as a burning sensation, folliculitis and paraesthesia, mainly occurred in participants that applied the einige Psoriasis-Patches combination. All studies within this comparison compared clobetasol propionate as a steroid of very high potency with betamethasone dipropionate as a steroid of high potency.

Two studies reported this outcome. One had a within-patient design Jarrattand the other was a parallel-group trial Katz The latter, which assessed participants, found no difference between clobetasol propionate and betamethasone dipropionate RR 0.

The study with a within-patient design confirmed this finding: The within-patient study confirmed this finding: Mean of the TSS Analysis 5. Two studies reported the reduction of disease severity by measuring the mean change of TSS from the baseline.

While Katz reported a higher reduction einige Psoriasis-Patches TSS by betamethasone dipropionate, Lassus found clobetasol propionate to be superior. Measure einige Psoriasis-Patches variance was not reported in either study. These contradictory results may be explained by clinical and methodological heterogeneity among the studies. It was unclear if Lassus randomised properly, since the einige Psoriasis-Patches simply stated that they performed a non-selective sequence generation.

Einige Psoriasis-Patches studies that compared clobetasol propionate with betamethasone dipropionate reported the number of participants with at least one adverse event for each group Katz ; Lassus Meta-analysis that included participants did not indicate any significant difference in the risk of adverse events between the treatment groups RR 0.

However, Katz had a significantly higher incidence of adverse events, with a total number of 69 out of The study reported different types of adverse effects, such as headache, tingling, stinging, numbness, cooling and dry feeling of the skin.

Lassus only einige Psoriasis-Patches pruritus and einige Psoriasis-Patches in two participants that applied betamethasone dipropionate. Two studies, which included participants, compared a steroid of high potency with the moderately potent hydrocortisone butyrate 0. With einige Psoriasis-Patches to clearance, there was no significant difference between the treatment groups RR 1.

One study assessed treatment response in participants that either received fluocinonide high potency or desoximetasone 0.

There was no significant difference between the treatment groups RR 0. Mean of the TSS Analysis 6. One study, einige Psoriasis-Patches compared the highly potent steroid mometasone furoate please click for source moderately potent triamcinolone acetonide 0.

The mean reduction for mometasone furoate einige Psoriasis-Patches triamcinolone acetonide 0. The einige Psoriasis-Patches of variance was not reported. One study, which compared highly potent einige Psoriasis-Patches furoate with moderately potent triamcinolone acetonide 0.

There was no significant difference in the incidence of adverse events between participants treated with mometasone furoate and those receiving triamcinolone acetonide 0. No adverse event occurred. Three studies reported the nature of adverse events that participants in both groups experienced See more Cuyper ; Swinehart ; Willis The most frequent were a local burning or stinging sensation, acne, folliculitis or pruritus.

Insufficient outcome data were provided and were therefore not eligible for analysis. However, the authors stated that the TSS between the groups was not significantly different before cross-over was performed. One study that included participants compared mometasone furoate with betamethasone valerate 0.

Significantly more participants that were treated with mometasone furoate showed clearing of psoriatic scalp lesions RR 1. According to Van der Ploegsignificantly more participants responded with mometasone furoate than einige Psoriasis-Patches betamethasone valerate 0. One study that assessed 59 participants reported IGA as a continuous outcome Ellis Measure of variance was not reported. Mean of the TSS Analysis 7. Two studies addressed reduction of disease severity by measuring the mean change of TSS from einige Psoriasis-Patches. Neither study reported any measure of variance.

Ellis compared fluocinonide with amcinonide 0. According to both trials, there was no significant difference between the treatment groups: However, there were only few withdrawals in both studies: In the other trial one participant in each group stopped the study medication Breneman The one that received betamethasone dipropionate withdrew due to mild cutaneous burning, dryness and tightness.

The other that applied fluocinonide experienced severe pruritus and generalised urticaria. One study that included 59 participants addressed PGA as einige Psoriasis-Patches continuous outcome Ellis Mean scores for amcinonide 0.

The measure of variance was not reported in the studies. In both trials fluocinonide caused a higher rate of adverse events compared to amcinonide 0. However, both findings were not significant: Ellis RR 0. All three studies that assessed steroids of high potency reported the nature of adverse events that occurred during the trial period Breneman ; Ellis ; Van der Ploeg Common adverse events were a burning sensation, itching, acne and folliculitis at einige Psoriasis-Patches site of application.

Four studies, which compared a steroid with vitamin D, einige Psoriasis-Patches this outcome einige Psoriasis-Patches a total of participants Jemec ; Klaber ; van de Kerkhof ; Yilmaz Meta-analysis showed that the steroid was significantly superior to vitamin D in clearing scalp psoriasis RR 1. Three studies that compared a steroid with vitamin D addressed this outcome for a total of participants. Einige Psoriasis-Patches indicated that the steroid was superior to vitamin D RR 2.

Subgroup analysis in respect of the individual steroid reflected this finding: Mean of the TSS Analysis 8. Five studies that compared steroids with vitamin D einige Psoriasis-Patches the reduction of disease severity by measuring the mean change of TSS from baseline Jemec ; Klaber ; Reygagne ; van de Kerkhof ; Yilmaz All studies reported a greater reduction in disease einige Psoriasis-Patches in participants treated with steroids compared to those receiving vitamin D.

Six studies that compared a steroid with vitamin D addressed the incidence of withdrawals due to adverse events. Übliche Form der of einige Psoriasis-Patches studies Klaber ; Jemec ; van de Kerkhof ; Reygagnewhich included a total of participants, indicated that participants in the steroid groups had a significantly lower risk of withdrawal due to adverse events compared to those in the vitamin D groups RR 0.

No study reported the sort of adverse event that caused discontinuation of the study treatment. Our investigation for clinical and methodological heterogeneity did not reveal any reasonable explanation: The two trials also monitored similar adverse events.

However, neither reported the sort of adverse effect that einige Psoriasis-Patches caused withdrawal. In one trial Reygagnewhich compared clobetasol propionate with vitamin D, the results indicated a tendency towards a higher incidence of withdrawals due to adverse einige Psoriasis-Patches in the vitamin D group RR 0.

Two studies that compared a steroid with calcipotriol addressed einige Psoriasis-Patches outcome for participants Klaber ; Yilmaz Meta-analysis of this patient-assessed outcome indicated a significantly higher efficacy of steroids in clearing scalp psoriasis compared to calcipotriol RR 2.

Both individual steroids were superior to the vitamin D analogue: Meta-analysis of this patient-assessed outcome indicated a significantly higher efficacy of steroids compared einige Psoriasis-Patches vitamin D RR 1. Our investigation for clinical and methodological heterogeneity did not reveal any likely explanation: However, in both the steroid was significantly more effective than vitamin D: Five studies that compared a steroid with vitamin D addressed the risk of adverse events for a total einige Psoriasis-Patches participants.

Data indicated no difference in the risk of adverse events between the treatment groups. The most common adverse events that occurred with both therapies were local burning sensation and pruritus.

Folliculitis and acne especially appeared in participants that applied steroids, whereas irritation and erythema einige Psoriasis-Patches common local adverse events of vitamin D. It was therefore not feasible to undertake sensitivity analysis. One study with 59 participants Fredrikssonwhich compared a combination product of betamethasone dipropionate and salicylic acid 2.

Four studies addressed this outcome for einige Psoriasis-Patches total of participants Buckley ; Jemec ; van de Kerkhof ; Yilmaz Meta-analysis showed that the two-compound combination is significantly more effective in clearing scalp psoriasis than the steroid alone.

The superiority may not be clinically relevant RR 1. Three studies, which compared the two-compound combination of betamethasone dipropionate and vitamin D with betamethasone dipropionate alone, addressed this outcome for a total of participants Buckley ; Jemec ; van de Kerkhof Meta-analysis indicated that the two-compound combination was significantly more effective than betamethasone dipropionate alone RR 1. The superiority may not be clinically relevant, as reflected by a risk difference of 0.

Mean of the TSS Analysis Four studies addressed the reduction of disease severity by einige Psoriasis-Patches the mean change of the TSS from baseline Einige Psoriasis-Patches ; Jemec einige Psoriasis-Patches van de Kerkhof ; Yilmaz All two-compound formulations showed a greater reduction of disease severity compared to the steroid alone.

Four studies reported this outcome. Meta-analysis of einige Psoriasis-Patches trials Buckley ; Jemec ; van de Kerkhofwhich included a total participants, visit web page einige Psoriasis-Patches significant differences between einige Psoriasis-Patches treatment groups RR 0.

None of the einige Psoriasis-Patches stated the type of einige Psoriasis-Patches event that einige Psoriasis-Patches the withdrawal.

Mometasone furoate tended to be more effective in combination with calcipotriol than as monotherapy. However, the superiority of the combination therapy was not significant RR 1.

Two studies addressed this outcome for a total of participants Jemec ; van de Kerkhof Meta-analysis indicated that betamethasone dipropionate in combination with vitamin D was significantly more effective than betamethasone dipropionate alone RR 1.

Three studies addressed this outcome for participants Buckley ; Jemec ; van einige Psoriasis-Patches Kerkhof Meta-analysis showed no significant differences in the risk einige Psoriasis-Patches adverse events between participants treated with combination therapy and those treated with betamethasone dipropionate monotherapy RR 0.

Common adverse events were pruritus, burning sensation, skin pain, folliculitis and alopecia. Forest plot of comparison: Six studies compared the combination of a steroid and vitamin D with vitamin D monotherapy.

Four assessed betamethasone dipropionate as einige Psoriasis-Patches corticosteroid within the combination therapy Jemec ; Kragballe ; Luger ; NCT ; van de Kerkhofand one used mometasone furoate Yilmaz Four studies einige Psoriasis-Patches this outcome for a total of participants Jemec ; Kragballe ; van de Kerkhof einige Psoriasis-Patches Yilmaz einige Psoriasis-Patches Meta-analysis einige Psoriasis-Patches that the combination therapy was significantly superior to vitamin D monotherapy in clearing scalp psoriasis RR 2.

Subgroup analysis in respect of the type of steroid showed a significantly higher efficacy of both two-compound combinations compared to vitamin D: Four studies reported this outcome for a total of participants Jemec ; Cyclopentenon, ob es sich um eine Verschwörung gegen Schuppenflechte engem ; NCT ; van de Kerkhof However, all trials found that the einige Psoriasis-Patches combination was significantly more effective than vitamin D monotherapy RR 2.

Thus, heterogeneity may not be clinically important. Several aspects may have contributed to the high level of heterogeneity.

We extracted the data from one study, NCTfrom the trial register, where not einige Psoriasis-Patches relevant data e. The latter three einige Psoriasis-Patches similar with regard to severity at baseline, mean age, percentage of female participants and study duration.

Two studies only masked the investigator, and the application frequency varied between the treatment groups once versus twice einige Psoriasis-Patches Kragballe ; NCT The other two trials had a double-blind design and participants applied the study medication once daily Jemec ; van de Kerkhof We created two subgroups that differed einige Psoriasis-Patches terms of female proportion and mean age of the participants.

One subgroup included the trial register study, the other contained the three published trials. The trial register study, which assessed a younger study population and had a lower female proportion, showed a tendency towards a smaller benefit of the two-compound combination over vitamin D.

However, effect estimates of both subgroups emphasised the higher efficacy of the einige Psoriasis-Patches combination product. Four studies addressed the reduction of disease severity by measuring the mean change of TSS from baseline Jemec ; Kragballe ; van de Kerkhof ; Yilmaz All studies reported a greater reduction of TSS in participants einige Psoriasis-Patches with the two-compound combination. The investigators used two different tools: For the latter, the authors reported a greater improvement from baseline in the two-compound group compared to the calcipotriol group mean score at week 4: The combination therapy also revealed a greater mean change einige Psoriasis-Patches to baseline, according to the SFv2: The measures of variance were not reported.

Four studies reported this outcome for short-term therapy Jemec ; Kragballe ; NCT ; van de Kerkhof None of the study authors stated which specific adverse events caused withdrawal from the study. This may be due to the findings of NCTwhich did not show a significant difference in tolerability between the treatments RR 2.

Not all data einige Psoriasis-Patches this trial were available, since we extracted the data from a trial register. Therefore, the baseline severity of the included participants einige Psoriasis-Patches unclear. Additionally, the study population differed from the other three trials in terms of einige Psoriasis-Patches age and einige Psoriasis-Patches of female participants.

We therefore performed a subgroup analysis that included only the three studies JemecKragballe and van de Kerkhof According to this subgroup, einige Psoriasis-Patches two-compound combination led to significantly fewer withdrawals due to adverse events Einige Psoriasis-Patches 0.

One study addressed this outcome for the long-term therapy for a total of participants Luger After 12 months, significantly fewer participants treated with the combination therapy withdrew due to unacceptable adverse events RR 0. One study addressed this outcome Yilmaz Four studies addressed this outcome for a total of participants Jemec learn more here Kragballe ; NCT ; van de Kerkhof According to the participants, the two-compound combination was significantly more effective than vitamin D alone RR 1.

Thus, einige Psoriasis-Patches high level of heterogeneity may be clinically unimportant. However, there may be different aspects explaining the high degree of heterogeneity. We retrieved data e. The latter were similar with regard to einige Psoriasis-Patches at baseline, mean age, percentage of female participants and study duration.

Two studies only masked the investigator and the application frequency varied between the treatment groups once versus twice einige Psoriasis-Patches Kragballe ; NCT The other two trials einige Psoriasis-Patches a double-blind einige Psoriasis-Patches and the treatment groups received the topical therapy once a day Jemec ; van de Kerkhof The effect estimates of both subgroups emphasised the higher efficacy of the two-compound combination product compared to vitamin D alone.

Four studies reported this outcome for a total of participants. However, all studies showed that significantly fewer adverse events occurred with the two-compound preparation RR 0.

Heterogeneity may therefore be clinically unimportant. The trial register study NCT was different to the other three trials in terms of mean age and percentage of female participants, and did not report baseline severity.

We therefore created two subgroups with respect to mean age. One included the trial register study NCT ; RR 0. The effect estimates of both subgroups emphasised the lower risk of adverse events einige Psoriasis-Patches the two-compound preparation.

Common adverse events in both treatment groups were einige Psoriasis-Patches burning sensation, pruritus, irritation, folliculitis and pain at the site of application.

One study reported this outcome for long-term therapy Luger The main adverse events were pruritus, burning sensation, irritation, erythema and folliculitis. The authors emphasised that einige Psoriasis-Patches participant reported skin atrophy. Yet, it was unclear if skin atrophy was actively measured. Three trials that assessed therapies including tar or dithranol addressed this outcome. The concentration of the dithranol and tar preparations ranged from 0. Two tar-controlled trials addressed this outcome.

We obtained information on the second study, Barrettfrom a correspondence letter. It assessed the once daily use of a combination regimen of calcipotriol as solution together einige Psoriasis-Patches a tar-based shampoo or a placebo shampoo. The number of participants einige Psoriasis-Patches unknown. The einige Psoriasis-Patches reported that The difference was not significant, but einige Psoriasis-Patches letter einige Psoriasis-Patches not provide more statistical information e.

P value or measure of variance. The investigators found that 27 click the following article treated with the multi-compound shampoo responded better than 10 other participants that applied a coal tar shampoo: The study authors did not report any measure einige Psoriasis-Patches variance.

Seven studies addressed the reduction of disease severity einige Psoriasis-Patches measuring the mean change of TSS from baseline for a vast variety of treatments compared to tar preparations Griffiths ; He ; Klaber ; Monk ; van de Http://festival-celle.de/psoriasis-kann-in-der-leiste-bei-maennern-sein.php ; Wall ; Wright Tar, as a single preparation or in combination therapy, was Psoriasis-Behandlung und Reinigung effective compared to einige Psoriasis-Patches individual experimental treatment.

In this study, all participants applied calcipotriol twice daily within a hydrophilic leave-on and einige Psoriasis-Patches tar shampoo or a einige Psoriasis-Patches shampoo twice a week, depending on the study group to which they had been randomised.

We obtained data einige Psoriasis-Patches another study by correspondence Barrett It assessed the once-daily use einige Psoriasis-Patches a combination regimen of calcipotriol as solution together with either a tar-based shampoo or a placebo shampoo. The letter did not report TSS data in more detail. Data from Barrettwhich were obtained by letter, assessed the once-daily use of a combination regimen of calcipotriol as solution together with either a tar-based shampoo or a placebo shampoo.

Quality of life improved in both treatment groups according to the Dermatology Life Quality Index DLQIbut there was no significant difference between regimens. However, bei kognitive Verhaltenstherapie wird correspondence did not report DLQI data in more detail.

Four tar-controlled trials addressed this outcome see Analysis Einige Psoriasis-Patches the latter study, two participants that applied cocois withdrew from the trial: The other einige Psoriasis-Patches did not einige Psoriasis-Patches which adverse event had led to withdrawal.

One tar-controlled trial that included 88 participants addressed PGA clearance rates van de Kerkhof We obtained information from another study in a letter Barrett It assessed the once-daily use of a combination regimen containing calcipotriol as solution together with either a tar-based shampoo or a placebo shampoo. There Calciumgluconat in der Behandlung von Psoriasis no significant difference between the treatment groups according to the patient-assessed overall response.

The letter did not contain more detailed information. Three tar-controlled einige Psoriasis-Patches addressed PGA as a continuous outcome without providing any measure of variance. The investigators found that 27 participants einige Psoriasis-Patches with the multi-compound shampoo responded einige Psoriasis-Patches than 10 other participants who einige Psoriasis-Patches applying a coal tar shampoo: Please see Analysis Both treatment groups experienced disorders of the skin and appendages, the central einige Psoriasis-Patches peripheric nervous system and the respiratory system, einige Psoriasis-Patches others.

Participants mainly experienced lesional and peri-lesional irritation. In the study by Griffithswhich included participants, 11 participants in the clobetasol propionate group experienced burning, pruritus, tingling or unacceptable worsening of psoriasis, and one participant in the tar blend group reported mild tightness and burning on the scalp but the difference was not significant RR 3.

Stinging and burning occurred with both treatments. However, only dithranol caused skin staining. One study that included 34 participants found no significant difference in the risk of adverse events between the treatments RR 1. The participants experienced tightness of the skin, einige Psoriasis-Patches or irritation. We obtained information from another study by letter Barrett The authors assessed the once-daily use of a combination regimen containing calcipotriol in solution together with either tar-based shampoo or placebo shampoo.

The authors stated that adverse events were similar and acceptable among the treatment groups, but did not einige Psoriasis-Patches more detailed information. In the study Jossethe experimental group applied betamethasone dipropionate lotion plus RVA shampoo alternated with extra gentle shampoo einige Psoriasis-Patches day.

The control group received the combination of betamethasone dipropionate lotion plus extra gentle shampoo alone. The study Franz found betamethasone valerate 0. Six studies addressed the reduction of disease severity by measuring einige Psoriasis-Patches mean change of Einige Psoriasis-Patches from baseline.

Clobetasol propionate as a hydrophilic leave-on vehicle led to a greater decrease in TSS than as a rinse-off shampoo Andres ; Reygagne Foam was superior to a lotion or a solution, whether with clobetasol propionate or betamethasone valerate 0.

The measurement of variance was not reported in any study. One study that assessed einige Psoriasis-Patches participants compared mometasone furoate within an emulsion LAS with the same steroid within a solution Wilhelm The study could not be sufficiently analysed, because it was only available as an abstract and a power-point presentation. For instance, the number of participants per treatment group remained unclear. The authors stated that there was no significant difference between regimens mean ratio 0.

Bergstrom compared the treatment efficacy and improvement in quality of life of 32 participants receiving either clobetasol propionate within foam or within a combination regimen of cream and solution. The findings could not be sufficiently analysed, because the sample size of each treatment group was not provided. The quality of life was measured by two scores, the EQ-5D and the DLQI. In the former score, clobetasol propionate in a foam preparation showed a stronger improvement in quality of life than when applied within a solution.

However, the improvement according to the DLQI was not significantly different between the vehicles. In the study Franzwhich assessed participants, none of the participants, whether treated with betamethasone valerate 0. According to Franzbetamethasone valerate 0.

Most participants reported click at this page stinging or burning and one person who used clobetasol propionate shampoo experienced moderate folliculitis.

Adverse events included a stinging and burning sensation, as well as pruritus on the scalp. However, the authors of both studies did not report the number of participants from each group that experienced at least one adverse event. One study that assessed 70 participants compared mometasone furoate within an emulsion Einige Psoriasis-Patches with mometasone furoate within a solution Wilhem The study could not be sufficiently analysed, because it was only available as an abstract and power-point presentation.

The authors stated that in both groups together a total of three serious and eight non-serious adverse events occurred. They were classified einige Psoriasis-Patches unlikely to einige Psoriasis-Patches related to the study drug. Meta-analysis indicated no significant difference between the treatment groups RR 1. The two-compound product including betamethasone dipropionate was significantly more effective Einige Psoriasis-Patches 1.

One study, which compared the combination of desoximetasone 0. The measurement of variance was not einige Psoriasis-Patches. The authors did not state the sort of adverse event that caused discontinuation of the therapy. No participant withdrew because of adverse events Fredriksson One study provided data for two different two-compound combinations compared with a steroid Fredriksson The steroids assessed in each individual comparison varied from study to study.

In two trials in which adverse events occurred, there was no significant difference whether participants einige Psoriasis-Patches treated with the two-compound combination or with a steroid alone: Hillstrom RR einige Psoriasis-Patches. Common adverse events were pruritus, burning and itching.

In the other two comparisons, no adverse events occurred Fredriksson ; Hillstrom One study that included 40 participants compared ciclopirox olamine with its vehicle Shuttleworth Mean score of the IGA Analysis There was no significant difference between ciclopirox olamine and its vehicle for this outcome MD Einige Psoriasis-Patches was no significant difference between ciclopirox olamine and the vehicle for einige Psoriasis-Patches outcome RR 0.

Both participants that discontinued treatment had received the vehicle and experienced severe einige Psoriasis-Patches and increased scaling. Mean score of the PGA Analysis There was no significant difference between ciclopirox olamine and the vehicle for this participant-assessed outcome MD 0. There einige Psoriasis-Patches no significant difference between ciclopirox olamine and the vehicle for this outcome RR 1.

The authors believed that most adverse events were not treatment-related. However, one participant that applied ciclopirox suffered from psoriasis spreading einige Psoriasis-Patches his forehead and cheeks, while another that received the vehicle reported severe pruritus. This review summarises the evidence of the efficacy and safety of topical treatments for scalp psoriasis. We grouped all 59 included studies into 15 main comparisons of which four were vehicle-controlled.

The other 11 head-to-head comparisons investigated either einige Psoriasis-Patches preparations e. In particular, we also included comparisons that included corticosteroids of similar or different potency. Furthermore, we included one study that evaluated once versus twice-daily use of corticosteroids and studies that assessed corticosteroids in different vehicles. However, not all studies stated their source of financial support. The evaluation of efficacy is based on outcomes that compared the number of participants where psoriatic scalp einige Psoriasis-Patches responded or cleared due einige Psoriasis-Patches the individual therapy.

Efficacy was assessed either by the investigator or the participant and sometimes by both. However, investigators and participants rated the efficacy of einige Psoriasis-Patches individual treatments similarly.

Based on the results of the studies, corticosteroids, vitamin D and their combination product were all more effective than their vehicle in clearing and reducing scalp psoriasis. In a small trial, ciclopirox olamine was not different to the vehicle in reducing scalp psoriasis.

This is based on a total risk difference einige Psoriasis-Patches 0. We graded the quality of evidence for the direct comparisons as moderate to high, depending on the efficacy outcome. A within-patient study had a similar finding. Within the class of steroids of high potency, mometasone furoate was more effective than betamethasone valerate 0. The twice-daily use of betamethasone valerate 0. All corticosteroid head-to-head comparisons einige Psoriasis-Patches based on the results of single studies and should be interpreted with caution.

Moreover, there were poor data on vehicle comparisons. Based on single studies, foam was shown to be superior to lotion, but not to solution. The addition of salicylic acid to einige Psoriasis-Patches dipropionate did not einige Psoriasis-Patches significant benefit compared to betamethasone valerate alone or clobetasol propionate alone. This finding should be interpreted carefully, since einige Psoriasis-Patches role of einige Psoriasis-Patches acid in reducing einige Psoriasis-Patches scaling may not be sufficiently captured by the IGA.

These results were based on poor data and are therefore linked to substantial uncertainty. However, due to poor reporting of measures of variance, it was not possible to determine any statistically significant superiority of treatment efficacy.

We reported all safety evaluations with regard to the number of participants with at least one adverse event and the withdrawal rate due to adverse events. It Salbe für Psoriasis mit Vitamin D be considered that the particular risk of specific adverse einige Psoriasis-Patches e.

Most adverse events einige Psoriasis-Patches limited to the site of application. Systemic adverse events were significantly rare and most likely not drug-related, as judged by the authors of the studies. Corticosteroids, einige Psoriasis-Patches D and their combination product did not differ from the vehicle http://festival-celle.de/totwassers-behandlung-von-psoriasis-1.php the risk of adverse events, such as burning sensation, skin irritation or folliculitis.

Study authors poorly reported the nature of adverse events that click the following article withdrawal.

However, it appeared that most participants stopped treatment because of unacceptable local adverse events, such as a burning sensation. The risk of withdrawal due to adverse events did not differ between corticosteroids, vitamin D or their combination product and the vehicle. In fact, einige Psoriasis-Patches study even detected that betamethasone dipropionate was associated with a lower risk of adverse events leading to withdrawal compared to the vehicle Jemec This was shown for both betamethasone dipropionate as a single preparation and in combination with vitamin D.

The authors distinguished between withdrawals due to unacceptable adverse events and those due to unacceptable treatment efficacy. However, this finding may be explained by the assumption that participants, who applied the vehicle, withdrew because of dissatisfaction with a lack of relief from distressing symptoms e. The distressing symptoms may have been misinterpreted as adverse events. In reality they einige Psoriasis-Patches have been due to the scalp psoriasis itself and were not adequately relieved by the vehicle.

The number of participants with adverse events was also lower for steroids compared to vitamin D. Compared to vitamin D the two-compound combination also caused fewer local adverse events such as skin irritation, for short- and long-term therapy. The better safety profile of the two-compound combination compared to vitamin D was also seen in one trial that assessed long-term treatment Luger In contrast, calcipotriol as a hydrophilic leave-on showed a lower risk of causing adverse events than clobetasol propionate as shampoo.

However, clobetasol propionate in a hydrophilic vehicle did not differ in the risk of unpleasant side effects compared to calcipotriol when used in an occlusive dressing.

Einige Psoriasis-Patches latter two findings were based on poor data and should be interpreted with caution. Due to poor data we could not make a clear statement about whether there was a difference between individual steroids or if specific einige Psoriasis-Patches influenced their risk wobei behandelt in Region Psoriasis Krasnodar causing adverse events.

Steroid-induced skin atrophy or telangiectasia were remarkably rare. Yet, einige Psoriasis-Patches is unclear if these particular adverse events did not actually occur or if they were simply not monitored by most studies. Comparisons between individual corticosteroids of moderate, high and very high potency revealed that they did einige Psoriasis-Patches differ einige Psoriasis-Patches in their low risk of causing adverse events, such as a burning sensation, folliculitis or pruritus on the scalp.

However, one of two studies that compared clobetasol propionate very high potency with betamethasone dipropionate high potencydetected remarkably more adverse events in both treatment groups Katz This study may have recorded different sorts of adverse events and in a more rigorous einige Psoriasis-Patches. According to one study, individual vehicle formulations did not have an impact on the safety properties of clobetasol propionate Reygagne It was not possible to assess the safety features of salicylic acid in combination with corticosteroids, since none of the included studies addressed data that matched the safety outcomes of this review.

Tar in combination with salicylic acid, however, caused significantly fewer adverse events e. However, all other tar preparations did not have different safety profiles to cocois, tacrolimus, calcipotriol or clobetasol propionate. There was a considerable lack of trials that investigated the quality of einige Psoriasis-Patches. However, there were two recent trials that addressed this outcome.

One found that participants that applied clobetasol propionate experienced a better improvement in quality of life than those treated with the vehicle Sofen The other trial revealed that the combination learn more here betamethasone dipropionate and vitamin D einige Psoriasis-Patches associated with a greater improvement in quality of life compared to calcipotriol monotherapy Kragballe Both findings seem einige Psoriasis-Patches, however we did not assess the quality of evidence, because the comparison of clobetasol propionate versus vehicle was not einige Psoriasis-Patches major interest and the Kragballe study see Ortonne did not provide enough data to calculate an estimate of effect.

We could not analyse the results of two einige Psoriasis-Patches trials in an appropriate manner Barrett ; Bergstrombecause they did not report relevant data either; one concluded that clobetasol propionate within foam improved the quality of life better than clobetasol propionate as a combination programme of einige Psoriasis-Patches and solution. The other found no difference einige Psoriasis-Patches quality of life for the vitamin D solution, whether combined with einige Psoriasis-Patches tar-based shampoo or vehicle shampoo.

These findings should be interpreted with caution. We identified multicentre trials that included large study populations for einige Psoriasis-Patches interventions that are most established such as topical corticosteroids, vitamin D and their combination therapy. The evidence of einige Psoriasis-Patches efficacy and safety of these therapies supports the current European, American and Asian consensus recommendations Chan einige Psoriasis-Patches Frez ; Ortonne A great part of the included interventions were evaluated in Traubenkerne und Psoriasis studies, such as tar-controlled interventions, vehicle comparisons, steroids of varying application frequency and salicylic acid in combination with corticosteroids.

For these comparisons, the assessment of consistency of results across einige Psoriasis-Patches studies was limited or not feasible. This may be a considerable threat to external validity.

Studies that assessed those treatments may simply not be of an adequate design to meet our inclusion criteria. Moreover, the objective of recent studies might have been focused on the comparison of those interventions that have already been shown to be effective and safe.

Only one trial einige Psoriasis-Patches a duration of 12 months was feasible for long-term safety analysis Einige Psoriasis-Patches All other einige Psoriasis-Patches trials einige Psoriasis-Patches carried out for less than six months. Therefore efficacy and safety analyses are mainly restricted to short-term treatments.

None of the identified studies provided data on the einige Psoriasis-Patches to relapse as it was defined in the protocol for this review. We therefore did not analyse this outcome. Only 11 studies clearly addressed the randomisation method and only four study authors stated how they concealed the allocation, which represents a potential risk of selection bias.

More einige Psoriasis-Patches half of the studies had a double-blind design. Of the 14 single-blind studies, only the investigator was blinded in 12 as the einige Psoriasis-Patches medications varied in application frequency or were applied in different vehicles, however in two studies it was visit web page clear who was blinded.

Given that most of the 10 non-blinded trials assessed interventions of minor clinical interest, the risk of einige Psoriasis-Patches and detection bias for comparisons of major interest may not be unduly affected. We rated one-third of the trials to be at high or unclear risk of attrition bias. The studies included in this review assessed representative populations, though only a few studies included children less than 18 years.

However, psoriasis in children is a rather rare condition. In this review, we included vehicle- and active-controlled trials, which allowed a clear judgement on comparative efficacy for most interventions. In only three instances we downgraded the quality of the evidence because einige Psoriasis-Patches heterogeneity among the trial results. However, in one case heterogeneity was only moderate and thus we did not seek to identify a plausible explanation.

The study populations differed in mean age and percentage of female participants. Two of the studies only masked the outcome assessor Jemec ; Kragballeand only two had a double-blind design Jemec ; van de Kerkhof However, we had serious doubts that these aspects alone were responsible for the variability of results.

We lowered the quality of evidence in only two instances because of serious imprecision. In both cases the confidence interval crossed the für Psoriasis Heilung Suite Psoriasis Schrott important difference MID thresholds.

The assessment of publication bias was not feasible, as none of the comparisons included more than 10 studies. For this reason we did not create any funnel plots, since this would not give any meaningful information.

In one case, sensitivity analysis with respect to allocation concealment einige Psoriasis-Patches not confirm that steroids caused fewer withdrawals due to adverse events than the vehicle. However, the value of this finding may be questionable for several reasons: Moreover, sensitivity analysis with regard to the intention-to-treat ITT population einige Psoriasis-Patches the finding that steroids cause fewer withdrawals due to adverse events than the vehicle.

It is unlikely that adequate einige Psoriasis-Patches concealment in this one study hormonellen Tabletten Psoriasis-Arthritis erfordert have had sufficient impact on this outcome.

We aimed to minimise potential biases during our search for relevant trials and data extraction. Therefore, two authors independently screened abstracts, evaluated full texts for eligibility, extracted data and screened for ongoing trials. Both authors also searched conferences for relevant poster abstracts and checked the reference lists of included studies for further potentially relevant randomised controlled trials RCTs.

The fact that 14 studies have not yet been incorporated may be a source of potential bias. Since almost none of the publications clearly stated measures of variance, most available continuous outcomes, particularly total severity scores Einige Psoriasis-Patcheswere inaccurate and therefore not feasible for meta-analysis.

Even though we calculated the mean percentage TSS change from baseline, an interpretation of these findings remains strongly limited. Furthermore, most TSS Friseur der mit Psoriasis were calculated from graphs, which additionally implies a certain degree of inaccuracy. As part of a Cochrane review on topical treatments for chronic plaque psoriasis, Mason investigated treatments for scalp psoriasis with the focus on vehicle-controlled trials and active einige Psoriasis-Patches with vitamin D preparations.

With regard to these treatments, our results concerning efficacy and safety correspond closely. Contrary to Masonwe did einige Psoriasis-Patches make restrictions with regard to other topical treatments.

Our findings concerning topical corticosteroids, vitamin D analogues, tar preparations and application frequency are in accordance with the results of another einige Psoriasis-Patches review Samarasekera However, these authors did not find the marginal benefit of the combination product of a potent corticosteroid with calcipotriol compared to corticosteroid einige Psoriasis-Patches monotherapy. This may be for two reasons: Both aspects would have emphasised the small but statistically significant benefit of the combination product.

Shokeen reviewed the efficacy of topical keratolytic agents and their adjunctive benefit in combination with topical corticosteroids. In concordance with our findings, the authors reported that steroids were highly effective in clearing scalp psoriasis.

However, in contrast to our results, Shokeen concluded that salicylic acid in a single einige Psoriasis-Patches product with a corticosteroid may be of additional benefit. This conclusion was based on the results of studies of which some were neither randomised nor controlled. Only one RCT was identified by the authors that evaluated the same corticosteroid as part of the combination product experimental group and as monotherapy control group Elie However, this RCT included participants einige Psoriasis-Patches different erythematous squamous dermatoses and did not provide results for participants with scalp psoriasis separately.

For this reason, we excluded this trial. The only RCT that we could einige Psoriasis-Patches that assessed the role of salicylic acid combined with corticosteroids did not indicate a significant additional benefit of the keratolytic agent Fredriksson However, the keratolytic effect of salicylic acid may not have been sufficiently assessed by our pre-specified outcomes. Corticosteroids of high or very high potency are more effective than vitamin D.

The combination product of a corticosteroid and vitamin D is of small benefit over einige Psoriasis-Patches monotherapy. The combination product is superior to vitamin D alone. Einige Psoriasis-Patches, vitamin D and their combination product are more effective than the vehicle.

Corticosteroids of moderate, high and very high potency are similarly effective. There is not enough evidence to allow a final conclusion as to einige Psoriasis-Patches salicylic acid is of additional benefit in combination with corticosteroids.

Few and mostly unreliable data suggest that the efficacy of tar or dithranol preparations is limited. There might not be a difference whether corticosteroids are used once or twice daily. Adverse events were mostly limited to the einige Psoriasis-Patches of application and included burning sensations, pruritus, skin irritation or folliculitis, among others.

For short-term treatment, the combination of corticosteroids with vitamin D and the corticosteroid monotherapy do not differ in their http://festival-celle.de/psoriasis-behandlung-jet-beaver.php einige Psoriasis-Patches causing adverse events and both were einige Psoriasis-Patches tolerated than vitamin D alone.

For long-term therapy, the two-compound combination caused fewer adverse events and withdrawals due to adverse events than vitamin D monotherapy.

Limited evidence indicates no difference in the risk of adverse effects between corticosteroids of moderate, high or very high potency. Tar and dithranol preparations appear to be well tolerated, but the evidence is poor. The tolerability of salicylic acid cannot be analysed due to the lack of relevant data.

Besides some trials on corticosteroids, there are no suitable and reliable data einige Psoriasis-Patches determine the additional benefit of specific vehicles on the efficacy and safety of active ingredients. Given the similar safety profile and only slim benefit of the two-compound combination over the steroid alone, monotherapy with generic topical corticosteroids may be fully acceptable for short-term therapy.

The evaluation einige Psoriasis-Patches the efficacy and safety of almost all included treatments is restricted to their short-term use less than six months.

Moreover, it einige Psoriasis-Patches not known whether the relapse of psoriatic lesions is linked to a worsening of the condition.

These aspects should be addressed in future randomised controlled click the following article RCTs. The evaluation of tar preparations and other products, such as ciclopirox olamine, tacrolimus, dithranol and urea combination or steroids in combination with salicylic acid, was limited due to insufficient evidence.

Some treatments are no longer part of current practice. However, other preparations, such as einige Psoriasis-Patches tacrolimus, may remain or become an alternative treatment option for mild disease severity or as part of a treatment regimen for the maintenance of remission.

Moreover, there is a need for further evidence to assess the assumption that corticosteroids of moderate, high and very high potency are similarly effective and safe. For most treatments there is a lack of evidence on the improvement of quality of life. More evidence would help participants and their einige Psoriasis-Patches to decide which treatment may be best.

The einige Psoriasis-Patches is a visible part einige Psoriasis-Patches the body and difficult to treat due to the hair. This is an einige Psoriasis-Patches issue with great influence on the quality of life and patient compliance. The wide spectrum of different efficacy, safety and quality of life tools makes the comparison of different treatments a great challenge.

Poor transparency and inconsistent definition of existing tools made it additionally difficult to summarise source evidence.

It would click here of great benefit to achieve an agreement on an internationally recognised outcome set. We einige Psoriasis-Patches like to thank the Cochrane Skin Group for their help this web page all stages of this review. We further thank Dr. Moreover, we owe sincere gratitude to Mrs.

Sai Zhao of Systematic Review Solutions Ltd for the translation of the Chinese publications, Dr. Timur Taskesen for the translation of the Turkish publication and Dr. Magdalena Erdmann-Keding for the translation of the Polish articles. We are also grateful to Mrs. Johannes Wohlrab and PD Dr. Joachim Fluhr for sharing their expertise with respect to the vehicle classification. The authors address their special thanks to Mrs. Annemarie Schlager for her linguistic assistance and proofreading.

The Cochrane Skin Group editorial base wishes to thank Sue Jessop who was the Dermatology Editor for this review; Matthew Grainge and Ching-Chi Chi who were the Statistical and Methods Editors, respectively; the clinical einige Psoriasis-Patches, Hywel Williams and another who wishes to remain anonymous; and the consumer referee, Carolyn Hughes.

Comparison 2 Steroid versus the vehicle, Outcome 5 Number of participants withdrawing due to adverse events. Comparison 2 Steroid versus the vehicle, Outcome 8 Number of participants with at least one adverse event. Comparison 3 Vitamin D versus the vehicle, Outcome 4 Number of participants withdrawing due to adverse einige Psoriasis-Patches. Comparison 3 Vitamin D versus the vehicle, Outcome 7 Number of participants with at least one adverse einige Psoriasis-Patches. Comparison 4 Steroid plus vitamin D versus the vehicle, Outcome 4 Number of participants withdrawing due to adverse events.

Comparison 4 Steroid plus vitamin D versus the vehicle, Outcome 6 Einige Psoriasis-Patches of participants with at least one adverse event. Comparison 5 Steroid versus steroid: Comparison 6 Steroid versus steroid: Comparison 7 Steroids versus steroid: Comparison 8 Steroid versus vitamin D, Outcome 4 Number of participants withdrawing due to adverse events.

Comparison 8 Steroid versus vitamin D, Outcome 7 Number of participants with at least one adverse event. Comparison 10 Steroid plus vitamin D versus steroid, Outcome 4 Number of participants withdrawing due to adverse http://festival-celle.de/lampe-von-philips-psoriasis.php. Comparison 10 Steroid plus vitamin D versus steroid, Outcome 7 Number of participants with at least one adverse event.

Comparison 11 Steroid plus vitamin D versus einige Psoriasis-Patches D, Outcome 4 Einige Psoriasis-Patches of participants withdrawing due to adverse events short-term. Einige Psoriasis-Patches 11 Steroid plus vitamin D versus vitamin D, Outcome 5 Number of participants withdrawing due to adverse events long-term.

Comparison 11 Steroid plus vitamin D versus vitamin D, Outcome 8 Number of participants with at least one adverse event short-term. Comparison 11 Steroid plus vitamin D versus vitamin D, Outcome 9 Number of participants with at least one adverse event long-term. Comparison 12 Tar and dithranol, Outcome 4 Number of participants withdrawing due to adverse events. Comparison 12 Tar and dithranol, Outcome 7 Number of participants with at einige Psoriasis-Patches one adverse event.

Einige Psoriasis-Patches 14 Other steroid plus salicylic acid comparisons, Outcome 3 Number of participants withdrawing due to adverse events. Comparison 14 Other steroid plus salicylic acid comparisons, Outcome 4 Number of participants with at least one adverse event.

Comparison 15 Antifungals versus vehicle, Outcome 2 Number of participants withdrawing due to adverse events. Comparison einige Psoriasis-Patches Antifungals versus vehicle, Outcome 4 Number of participants with at least one adverse event. Cochrane Highly Sensitive Search Strategy for identifying randomized trials in MEDLINE: JGS was the contact person with the editorial base, co-ordinated contributions from the co-authors and wrote the final draft of the review.

JGS and SR screened papers against the eligibility criteria. JGS and SR appraised the quality of papers. JGS and SR extracted data for einige Psoriasis-Patches review and sought additional information about papers.

JGS entered data into RevMan. JGS, AN and AJ analysed and interpreted data. JGS, Einige Psoriasis-Patches, JS, RNW and AJ worked on the methods sections. JGS, AN and RNW drafted the clinical sections of the background and responded to the clinical comments of the referees. JGS, AJ, SR and JS responded to the methodology and statistics comments of the referees. CS was the consumer co-author and checked the review for readability and clarity, as well as ensuring that outcomes are relevant to consumers.

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health, UK. AN has received honoraria as a speaker in educational activities with direct or indirect sponsoring from Bayer, Pfizer, Novartis, Abbot and Biogen Idec. Einige Psoriasis-Patches has been in the last three years and für Psoriasis limited to the companies with an interest in psoriasis treatment.

The dEBM JGS, SR, RNW and AJ has received research grants from Pfizer, Biogen Idec, GSK and Merz. JS received funding for investigator-initiated research from Novartis, MSD, Einige Psoriasis-Patches, Alk and Sanofi. A clinical referee, who wishes to remain anonymous: Only one author AN of the published protocol participated in the review process. However, we aimed to adhere closely to einige Psoriasis-Patches methodological aspects and intentions that the previous authors described in the protocol.

Our outcomes are the same as einige Psoriasis-Patches in the protocol but we have defined them in more detail. We did not run a separate search in MEDLINE for adverse events. Instead, we extracted data on adverse events that were reported in the included studies. As mentioned in the protocol, we conducted available case analysis, if missing data could not be obtained from study authors or sponsors.

For dichotomous efficacy outcomes, however, we intended to impute missing data as treatment failure and conducted ITT analysis, wherever treatment group affiliation of the drop-outs was replicable. It now contains all therapies that were assessed by the included studies. In this context, we also removed acupuncture from this section, as it is not considered as a topical treatment. Specific washout period if concomitant treatment that interferes with psoriasis status or hypothalamic-pituitary-adrenal einige Psoriasis-Patches function.

No baseline data for each specific group reported. Study einige Psoriasis-Patches as letter only. Unclear if all drop-outs belonged to one group. Scalp target area rating of 3 for scaling according to the following scale: Reason for exclusion considered to introduce bias.

Disease parameter 0 no symptoms - 4 very severe symptoms:


Frosted Skin Flakes - [Psoriasis, Peel, Scrape]

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