A Comparative Clinical Evaluation of Once Daily Versus Alternate Day Application of Topical Clobetasol Propionate Cream in Psoriasis

Background: Corticosteroids are extremely useful in the treatment of inflammatory skin disorders. Topical steroid applications are the most effective treatment for all types of psoriasis. Aims: To compare the efficacy of once daily versus alternate day application of topical steroid clobetasol propionate 0.05% (Tenovate cream (R)) in patients who have mild to moderate plaque psoriasis. Settings and Design: This study was conducted on 89 patients of plaque psoriasis, who attended the skin OPD in our hospital. Methods and Material: The patients who had a mild to moderate severity of plaque psoriasis were selected. Those patients who required systemic corticosteroids, those who were already undergoing any psoriasis treatment, those who had any other debilitating illness and pregnant and lactating women were excluded from the study. Eighty nine patients were enrolled for the study after taking written informed consent from them and they were randomly allocated into two groups. Two patients dropped out, one in each group and 1 of group 2 was prescribed systemic corticosteroids. Group 1-once daily application (n=44) Group 2-alternate day application (n=42) An objective scoring was done on the basis of the PSI (Psoriasis Severity Index) score, which was graded from 0-4. Follow ups were done in the 2nd, 4th and 6th weeks. Statistical Analysis: It was done by the Student's 't' test and ANOVA. Results and Conclusions: The results showed that there was equal improvement in both the groups in the 2nd week, since the p-value was not significant (P>0.05), but in the 4th and 6th weeks, there was less improvement in the alternate day group (P<0.05). An intra group comparison indicated that clobetasol was effective both in the once daily and the alternate day groups, but clinical and symptomatic improvement occurred more quickly in the once daily group after 6 weeks of assessment. Thus, it can be concluded that the alternate day application of the topical steroid clobetasol propionate cream is as effective as the once daily application in the initial 2 weeks, but by 6 weeks, its efficacy decreases. Therefore, initially, we can advocate a less frequent application of potent topical steroids but for the complete remission of the disease, the application frequency should be once daily.