EVALUATION OF THE EFFICACY AND SAFETY OF 0.05% HALOBETASOL PROPIONATE OINTMENT AND 0.05% CLOBETASOL PROPIONATE OINTMENT IN CHRONIC, LOCALIZED PLAQUE PSORIASIS

Psoriasis is a common, chronic, inflammatory, multisystem disease involving the skin and joints. It accounts for 2.3% of the total dermatology outpatients in India.  Corticosteroids have an important role in skin diseases because of their anti-inflammatory, immunosuppressive, and anti-proliferative effects on the keratinocytes.Topical corticosteroids are commonly used in the management of psoriasis and other inflammatory skin disorders. Clobetasol 0.05% ointment and halobetasol 0.05% ointment are synthetic class I super-potent topical corticosteroids with anti-inflammatory, anti-pruritic and vasoconstrictive properties commonly prescribed for the treatment of psoriasis. The current study conducted in 202 patients from 6 centers showed a significant reduction in LPSI scores at end of treatment. The physician's global evaluation rating at end of treatment of almost total clearing of lesion (Grade 4) was reported in 19.2% and 32% patients, marked improvement (Grade 3) in 47.5% and 50.5%, moderate improvement (Grade 2) in 30.3% and 17.5% and mild improvement (Grade 1) in 3% and 0% for Clobetasol and Halobetasol groups respectively. The difference between the two groups for physicians' global evaluation was found to be statistically significant (p=0.019). 19.2% and 27.2% patients in Clobetasol and Halobetasol respectively, showed >75% improvement in photographic assessment (p=0.521).  There was a significant difference in the cosmetic acceptability (p=0.042) & in the ease of application (p=0.019) between the two groups.  No significant difference was found in serum cortisol levels, in both groups (p=0.074).Therefore this study reaffirms that halobetasol has better efficacy and good tolerability profile compared to clobetasol

Monitoring of Vitiligo Patches Over 6 Months to Validate Dermoscopic Findings of Lesional Stability

Background: Previously laid down criteria for lesional stability of vitiligo are inconsistent. Longitudinal data on correlation between dermoscopic features of vitiligo and disease activity is limited. Objective: To sequentially determine the dermoscopic features of vitiligo and to assess their association with the dynamic nature of the vitiligo patch. Methods: Sixty patients with 200 vitiligo patches fulfilling the inclusion criteria on medical therapy were subjected to sequential clinical and dermoscopic examination for 6 months. Baseline lesional photographs, dermoscopy and tracing of the patch was made and repeated at 6 months. The follow up tracing was superimposed onto the baseline tracing. Based on the increase or decrease in size, their outcomes were grouped as responsive, progressive and quiescent. Paired analysis of dermoscopic features was done between baseline, and their follow up after 6 months. Results: Well defined border was associated with static nature of the vitiligo patch and ill-defined borders and trichrome pattern depicted its dynamic nature. Statistically significant increase in leukotrichia and satellite lesions amongst progressive patches and a decrease amongst responsive patches was observed. Pigment network changes were statistically significant for both responsive and progressive patches. Satellite lesions and micro-Koebner’s phenomena was suggestive of progressive disease, while perifollicular pigmentation and perilesional hyperpigmentation was suggestive of repigmenting disease and proved to be an early marker for response to therapy. Conclusions: Repeated dermoscopic evaluation of lesions in a serial manner to assess disease activity helps understand their evolving nature and is a valuable tool in planning appropriate further treatment