News

Coal Tar Solution Tops Calcipotriol Cream for Psoriasis


 

SAN FRANCISCO — A novel over-the-counter topical leave-on coal tar solution achieved significantly greater and more persistent improvement compared to prescription calcipotriol cream in patients with moderate chronic plaque psoriasis in a randomized trial.

Equally noteworthy was the participants' rating of the topical coal tar solution as comparable to calcipotriol cream in terms of cosmetic acceptability, convenience, and aesthetics, Dr. Maria Beatrice Alora-Palli noted at the annual meeting of the American Academy of Dermatology.

For centuries topical coal tar has been recognized as safe and reliably effective for controlling the symptoms of plaque psoriasis. In recent decades, however, topical coal tar in its traditional form has come to be viewed as an unacceptably foul therapy: messy, inconvenient, smelly, and staining.

The novel coal tar solution, marketed as Psorent by NeoStrata Co., is a fast-drying product engineered to circumvent those shortcomings. It contains 15% liquor carbonis distillate, equivalent to 2.3% coal tar.

Dr. Alora-Palli of Massachusetts General Hospital, Boston, presented an 18-week investigator-blinded randomized trial involving 55 adults with chronic plaque psoriasis over 3%-15% of their body surface area. They applied either the topical coal tar solution or calcipotriol cream 0.005% (Dovonex) twice daily for 12 weeks, followed by a 6-week follow-up assessment of regression of improvement, during which the coal tar solution clearly outperformed the calcipotriol cream.

Twelve weeks of therapy resulted in a Psoriasis Area and Severity Index (PASI) 50 in 67% of the coal tar group, compared with 36% of those on calcipotriol cream. A PASI 75 was attained by 37% of the coal tar group and no one in the calcipotriol cream study arm. Moreover, PASI scores improved by a mean of 58% in the coal tar group, compared with 37% in the calcipotriol cream group.

Physician Global Assessment scores improved in the coal tar group from a mean of 3.1 at baseline to 1.3 at week 12 and 1.6 at week 18. This was significantly better than the scores in the calcipotriol group, which went from 2.9 at baseline to 2.0 at 12 weeks and then rebounded significantly to 2.6 at 18 weeks, Dr. Alora-Pilli continued.

During the first 6 weeks after completing 12 weeks of treatment, the coal tar solution group reported significantly better control of itch, redness, scaling and flaking, and skin texture changes than did the calcipotriol cream group.

A total of 70% of the coal tar group reported having good control of the overall discomfort and appearance of their psoriatic lesions, compared with about half as many patients in the calcipotriol group.

Psorent is supplied in 100-mL bottles topped with a dab-on applicator that enables patients to avoid touching the medication or their skin lesions.

Dr. Alora-Pilli received a research grant to conduct the NeoStrata-funded study.

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