| Psoriasis is a common chronic and recurrent skin disease with profound and negative effects on the physical and mental health of patients.External drugs play an important role in the treatment of psoriasis.Actually,there are multiple drugs for external use,but the efficacy and safety are difficult to confirm.Dovobet,a two-compound product containing calcipotriol(50ug/g)and betamethasone dipropionate(0.5 mg/g),is a kind of compound preparations.Clinical observations found that its more effective than calcipotriol or corticosteroid alone for psoriasis vulgaris.Well,it's still need an evidence-based evidence with multicenter and large sample.Dermoscopy is a noninvasive microscopy image technology,it's significance for diagnosing melanoma,pigment skin disease has been recognized by the dermatologists all around the world.Recently,it has been used in the non-pigmented tumors,inflammatory skin diseases,dermatitis,granulomatous skin diseases and so on.Dermatoscope can not only be used in disease diagnosis and identification,but also evaluate the therapeutic effects by observing the change of background color,blood vessels or other skin structures.ObjectiveTo evaluate the efficacy and the safety of Dovobet in the treatment of psoriasis vulgaris by a meta-analysis.To observe the change of psoriasis skin lesions and the blood vessels after treated by Dovobet.Methods1.12 English and Chinese databases were searched from their inception to October 2017.Randomized controlled trials(RCTs)about treating psoriasis vulgaris by Dovobet were looked up.All RCTs used to assess the evidence for efficacy and safety outcome,the risk of bias assessment and the GRADE assessment were conducted in accordance with Cochrane Collaboration methodology.Data were analyzed in RevMan5.3.2.Select 38 cases of psoriasis patients continuously treated by Dovobet.Erythema,scaling,infiltration were scored and recorded on 0,2,4,6 weeks.At the same time,using dermoscopy to do dynamic continuous observation of vascularchanges in the same skin lesions.All of the data were confirmed by SPSS10.0software for statistical analysis.Results1.11 RCTs included,7 in IGA,5 in PGA,5 in PASI compared the efficacy,while 5 RCTs evaluated the safety.Through IGA and PGA we found the 2-compound formulation was significantly more effective than both calcipotriol and betamethasone in 2,4 and 8 weeks.The efficacy of Dovobet in 8 weeks was significantly more useful than 4 weeks' and 2 weeks',there were statistical differences.PASI as evaluation index,we chose the descriptive statistical analysis,found that after 4 weeks' treatment Dovobet groups' reduction of patient's average PASI from the baselines were significantly higher than the calcipotriols' and betamethasones'.Safety analysis showed Dovobet was more safety than calcipotriol and placebo in 4 weeks and 8 weeks,but there was no significant difference with betamethasone.2.After treated by the Dovobet,psoriasis lesions faded away and the diameter of the blood vessels were smaller.The decrease rate of the clinical lesion score was significantly greater than that of the blood vessel diameter after treatment.The target lesion score of lesions was positively correlated with the diameter of the blood vessels,and the correlation between the two was increased as the treatment time prolonged.Conclusion1.Dovobet has more advantages than calcipotriol and betamethasone for psoriasis vulgaris,Meta-analysis with high quality provides effective and objective evidences for the clinic choice.2.Clinical observation and dermoscopy observation confirmed that Dovobet is effective to psoriasis vulgaris.Clinical changes came to light earlier than vascular changes,while the dermoscopy changes can be used for psoriasis condition assessment and guiding drug selection... |
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