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GPs and Dermatologists have a new treatment option for scalp psoriasis with the launch of Xamiol® (pronounced "zamiol"), a once-daily gel formulation containing the proven combination of the Vitamin D analogue calcipotriol 50 microgram/g (as monohydrate) and the corticosteroid betamethasone 0.5 mg/g (as dipropionate). It is indicated for once-daily topical treatment of scalp psoriasis in adults and is recommended for four weeks and thereafter repeat treatment can be initiated under medical supervision.2

In the published pivotal clinical trial, Xamiol® gel was demonstrated to be effective with a rapid onset of action; 57.5% of patients achieved control ('absent' or 'very mild' disease) after just two weeks' treatment with Xamiol® gel, compared to calcipotriol in the same vehicle (18.8%), betamethasone dipropionate in the same vehicle (47.1%) or vehicle alone (11.8%). Following four weeks' treatment with Xamiol® gel, 66.9% of patients experienced control ('absent' or 'very mild' disease), compared to calcipotriol in the same vehicle (23.5%), betamethasone dipropionate in the same vehicle (54.7%) or vehicle alone (14.7%).1

Dr Anthony Bewley, Consultant Dermatologist from Whipps Cross University Hospital, London, who has been involved in the Xamiol® clinical trials said: "In practice, patients begin to see improvements in the scaling and inflammation in just two weeks, with control of their disease in most cases after four weeks. Previous treatments for scalp psoriasis were often very messy and unpleasant, so the fact that Xamiol® works so quickly, coupled with the fact that it is relatively convenient and easy to use, helps with patient concordance."

Cosmetic acceptability and ease of use are important for patient compliance and treatment success. Xamiol®, an almost clear and odourless gel, differs from traditional scalp psoriasis treatments such as coal tar and dithranol, which can be messy to use or have a strong odour.3 Compliance with once-daily psoriasis treatments is almost double that seen with twice-daily therapies (demonstrated in a study examining oral and topical psoriasis treatment compliance).4

Xamiol® gel is applied to the affected areas of the scalp once-daily.2 To achieve optimal effect, it is recommended that the hair is not washed immediately after application, but it should remain on the scalp during the night (or during the day if preferred). The hair should then be washed by applying shampoo to dry hair, waiting for a couple of minutes and then washing as normal.

Xamiol® gel is generally well-tolerated.1,5 An eight week randomised controlled trial found that pruritus was the most commonly reported adverse event occurring in 2.8% of patients using Xamiol® gel compared to 6% with calcipotriol and 6.7% with vehicle alone.1 The relatively low incidence of pruritus with Xamiol® gel could suggest a complementary mode of action of betamethasone to minimise irritation from the Vitamin D component.1 Furthermore, a 52-week safety study found a low incidence (2.6%) of adverse events possibly related to corticosteroid use following intermittent Xamiol® gel treatment and there were no incidences of skin atrophy.5

About scalp psoriasis

- Scalp psoriasis is seen in up to 80% of patients with psoriasis.6

- It can be distressing for patients to live with because of its visibility: patients may avoid social situations and can feel embarrassed, isolated and depressed.7

- Despite a range of therapy options, scalp psoriasis remains difficult to treat.3

About the treatment of scalp psoriasis

- The joint BAD/PCDS (British Association of Dermatologists and Primacy Care Dermatology Society) guidelines recommend that most patients with mild or moderate psoriasis can be treated in primary care with topical therapies.8

- Treatments with proven efficacy benefits for scalp psoriasis include potent/very potent corticosteroids, Vitamin D analogues and combinations of very potent corticosteroids and calcipotriol.3 Other useful topical treatments include coal tar, salicylic acid and dithranol.

- Topical treatments often come as an alcohol-based lotion, a gel, foam or shampoo. Greasy ointments or strong smelling treatments are associated with poor patient acceptance.3

About LEO Pharma

LEO Pharma this year celebrates its centenary. Xamiol® gel adds to its existing portfolio of dermatology treatments, which include Dovobet® (calcipotriol /betamethasone dipropionate), a combination treatment for psoriasis, Dovonex® (calcipotriol) for psoriasis, and Fucidin® (fusidic acid), an antibiotic used alone for impetigo or in combination with hydrocortisone (Fucidin®H) or betamethasone valerate (Fucibet®) for infected eczema. http://www.leo-pharma.com

References

1. Jemec GBE, Ganslandt C, Ortonne JP et al. A new scalp formulation of calcipotriene plus betamethasone compared to its active ingredients and vehicle in the treatment of scalp psoriasis: a randomized, double-blind, controlled trial. J Am Acad Dermatol 2008; 59(3):455-63.

2. Xamiol® Summary of Product Characteristics. LEO Pharma. September 2008.

3. Papp K, Berth-Jones J, Kragballe K et al. Scalp psoriasis: a review of current topical treatment options. J Eur Acad Dermatol Venereol 2007;21:1151-1160.

4. Zaghloul SS and Goodfield MJD. Objective assessment of compliance with psoriasis treatment. Arch Dermatol 2004; 140: 408-414.

5. Luger T, Cambazard F, Larsen FG, Bourcier M, Gupta G, Clonier F, Kidson P, Shear NH. A study of the safety and efficacy of calcipotriol and betamethasone dipropionate scalp formulation in the long-term management of scalp psoriasis. Dermatol 2008; 217: 321-328

6. van de Kerkhof PCM, Steegers-Theunissen RPM, Kuipers MV. Evaluation of topical drug treatment in psoriasis. Dermatology. 1998; 197: 31-36.

7. Data on file: market research conducted by Hall & Partners Healthcare for LEO Pharma. March 2008.

8. BAD/PCDS Clinical guidelines for Psoriasis. September 2006.

LEO Pharma