Safety data from the various therapies were also reviewed in this analysis.1 Study results indicated that patients treated with vitamin D were more likely to withdraw from the study due to adverse events compared to those treated with corticosteroids. In addition, the risk of withdrawal due to adverse events for the combination product group was the same as the corticosteroid group but less than that of the vitamin D group. The authors also noted the difficulty in assessing the safety of specific corticosteroids or vehicles due to poor quality of evidence. All efficacy and safety results are summarized in Table 2.

The quality of evidence reviewed in this study was generally rated as moderate.1 There were also several potential sources of bias present in this meta-analysis. The authors noted that numerous studies introduced selection bias by using inappropriate randomization techniques, allocation concealment, or blinding methods. Additionally, about half of the studies did not report data for outcomes that were pre-stated in the methods section. Other weaknesses included results obtained from short-term data only, manufacturer financial sponsorship, and other additional sources of bias found in individual studies.

Although evidence for the efficacy and safety for scalp psoriasis treatment options has been unclear in the past, this meta-analysis has demonstrated important results indicating appropriate treatment for this disease. Analysis found that corticosteroids not only were the most effective treatment for scalp psoriasis, but were also the safest option as well. Although a specific corticosteroid or formulation was not found to be preferred, a corticosteroid of high or very high potency, prescribed using a formulation to ensure patient compliance, should increase the chance of treatment success.

Table 1

Therapy

Advantages

Disadvantages

Corticosteroids

— First-line treatment

— Various formulations and potencies available

— Adverse events (long-term therapy): cutaneous atrophy, telangiectasia, diabetes, hypertension, HPA axis suppression

Vitamin D analogs (calcitriol, calcipotriol, tacalcitol)

— Alternative therapy

— Considered safe

— Potential peri-lesional irritation upon initiation

Calcitriol and tacalcitol – risk of increase in serum and urine calcium levels (do not exceed 100g/week)

Tar-based products (pine tar, coal tar)

— Coal tar – more effective

— Possess anti-inflammatory, anti-proliferative, and pruritus-reducing properties

— Cosmetically unappealing features, unpleasant smell

— Mutagenic potential

Calcineurin inhibitors

— Alternate therapy

— Carcinogenic risk

— Not yet approved to treat psoriasis

Anthralin (dithranol)

— Adverse events: hair discoloration, skin irritation

— May be easier to apply during hospitalization versus outpatient

Salicylic acid

— Often used as initial treatment for patients with excessive scaling

— Various formulations available

— Increases the penetration of other agents (useful for combination products)

Antifungals (Broad-spectrum azoles)

— Can potentially treat the overgrowth of Pityrosporum (Malassezia yeast)