Lauren Margaret T. Hao, MD, DPDS , Eleanor L. Letran, MD, FPDS
Background: Niacinamide is known for its anti-inflammatory effect and skin penetration capability. Currently, limited studies are available on its efficacy on psoriasis.
Objective: This study aimed to determine the efficacy and safety of 4% niacinamide cream on mild to moderate psoriasis.
Methods: 40 patients were randomly allocated to 4% niacinamide cream (N), or 0.1% triamcinolone acetonide cream (TAC) or 4% niacinamide cream and 0.1% triamcinolone acetonide cream (N-TAC) for 10 weeks treatment. A 50% improvement in psoriasis area severity index (PASI50) was considered as the primary endpoint of the study. Secondary outcome measures were physician global assessment (PGA), dermatology life quality index (DLQI), and adverse events. PASI and PGA were assessed biweekly. DLQI was assessed at the start and at the end of the study period.
Results: PASI50 was achieved in 85% of patients in N-TAC, 75% of patients in TAC and 15% of patients in N. There was no statistical significant difference between groups TAC and N-TAC (p=0.645, Fisher's exact test). A higher number of patients in N-TAC (31%) achieved PGA1 score or “almost clear” and reached PASI50 earlier (60% at week 4). A higher improvement in DLQI score was seen in N-TAC; however, mean DLQI improvement did not vary by treatment group (p=0.0770). No adverse event was reported for groups TAC and N-TAC while pruritus and erythema were noted in N.
Conclusion: Monotherapy of 4% niacinamide cream was not effective in the treatment of mild to moderate psoriasis. The combination N-TAC showed a continuous and sustained improvement of lesions compared to monotherapy TAC.
Hao, LMT, Letran, EL. A double-blind, randomized controlled trial on the efficacy and safety of 4% niacinamide cream on the treatment of mild to moderate chronic plaque psoriasis at the University of Santo Tomas Hospital Out-Patient Department. J Phil Dermatol Soc 2019, 29(2), 20-34
- Newman M, Weinberg J. The pathophysiology of psoriasis. In: Weinberg J, editor. Treatment of Psoriasis. 2008. p. 11–20.
- Korman NJ, Zhao Y, Pike J, Roberts J. Relationship between psoriasis severity, clinical symptoms, quality of life and work productivity amongpatients in the USA. Clin Exp Dermatol. 2016;41(5):514–21.
- Prignano F, Ricceri F, Pescitelli L, Lotti T. Itch in psoriasis: epidemiology, clinical aspects and treatment options. Clin Cosmet Investig Dermatol. 2009;2:9–13.
- WHO. Global Report on Psoriasis. WHO Press. 2016;978(9):48.
- Roa F. The Philippines – Treatment of Psoriasis and its Challenges. IPC PSORIASIS Rev. 2010;6(1):3–4.
- Wan T, Pan W, Long Y, Yu K, Liu S, Ruan W, et al. Effects of nanoparticles with hydrotropic nicotinamide on tacrolimus: Permeability through psoriatic skin and antipsoriatic and antiproliferative activities. Int J Nanomedicine. 2017;12:1485–97.
- Emanuele E, Bertona M, Altabas K, Altabas V, Alessandrini G. Anti-inflammatory effects of a topical preparation containing nicotinamide, retinol, and 7-dehydrocholesterol in patients with acne: A gene expression study. Clin Cosmet Investig Dermatol. 2012;5:33–7.
- Washio H, Hara H, Suzuki H, Yoshida M, Hashimoto T. Bullous pemphigoid on psoriasis lesions after UVA radiation. Acta Derm Venereol. 2005;85(6):561–3.
- Navarrete-Solís J, Castanedo-Cázares JP, Torres-Álvarez B, Oros-Ovalle C, Fuentes-Ahumada C, González FJ, et al. A double-blind, randomized clinical trial of niacinamide 4% versus hydroquinone 4% in the treatment of melasma. Dermatol Res Pr. 2011;2011:379173.
- 10. Levine D, Even-Chen Z, Lipets I, Pritulo OA, Svyatenko T V, Andrashko Y, et al. Pilot, multicenter, double-blind, randomized placebo-controlledbilateral comparative study of a combination of calcipotriene and nicotinamide for the treatment of psoriasis. J Am Acad Dermatol. 2010;63(5):775–81.
- Siadat AH, Iraji F, Khodadadi M, Jary MK. Topical nicotinamide in combination with calcipotriol for the treatment of mild to moderate psoriasis: A double-blind, randomized, comparative study. Adv Biomed Res. 2013;2(2277-9175 (Electronic)):90.
- Choonhakarn C, Busaracome P, Sripanidkulchai B, Sarakarn P. A prospective, randomized clinical trial comparing topical aloe vera with 0.1% triamcinolone acetonide in mild to moderate plaque psoriasis. J Eur Acad Dermatol Venereol. 2010;24(2):168–72.
- Liu LS, Kang Y, Antaya R. Prospective Trial Comparing Topical Steroid Application To Wet Versus Dry Skin In Children With Atopic Dermatitis. 2014.
- Brunner PM, Khattri S, Garcet S, Finney R, Oliva M, Dutt R, et al. A mild topical steroid leads to progressive anti-inflammatory effects in the skin of patients with moderate-to-severe atopic dermatitis. J Allergy Clin Immunol. 2016;138(April):169–78.
- Kim DH, Lee HJ, Park CW, Kim KH, Lee KH, Ro BI, et al. The clinical efficacy of mometasone furoate in multi-lamellar emulsion for eczema: A double-blinded crossover study. Ann Dermatol. 2013;25(1):17–22.
- Dogra S, Mahajan R. Psoriasis: Epidemiology, clinical features, co-morbidities, and clinical scoring. Indian Dermatol Online J. 2016;7(6):471.
- Bożek A, Reich A. The reliability of three psoriasis assessment tools:
Psoriasis area and severity index, body surface area and physician global
assessment. Adv Clin Exp Med. 2017;26(5):851–6.
- Schmitt J, Wozel G. The psoriasis area and severity index is the adequate criterion to define severity in chronic plaque-type psoriasis. Dermatology. 2005;210(3):194–9.
- Carlin CS, Feldman SR, Krueger JG, Menter A, Krueger GG. A 50% reduction in the Psoriasis Area and Severity Index (PASI 50) is a clinically significant endpoint in the assessment of psoriasis. J Am Acad Dermatol. 2004;50(6):859–66.
- Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 2008;58(5):826–50.
- Badia, Mascaró, Lozano. Measuring health-related quality of life in patients with mild to moderate eczema and psoriasis: clinical validity, reliability and sensitivity to change of the DLQI. Br J Dermatol. 1999;141(4):698–702.
- Fleming C, Ganslandt C, Guenther L, Johannesson A, Buckley C, Simon JC, et al. Calcipotriol plus betamethasone dipropionate gel compared with its active components in the same vehicle and the vehicle alone in the treatment of psoriasis vulgaris: A randomised, parallel group, double-blind, exploratory study. Eur J Dermatol. 2010;20(4):465–71.
- Kaufmann R, Bibby AJ, Bissonnette R, Cambazard F, Chu AC, Decroix J, et al. A new calcipotriol/betamethasone dipropionate formulation (DaivobetTM) is an effective once-daily treatment for psoriasis vulgaris.Dermatology. 2002;205(4):389–93.
- Elmariah SB, Lerner EA. Topical therapies for pruritus. Semin Cutan Med Surg. 2011;30(2):118–26.
- Coondoo A, Phiske M, Verma S, Lahiri K. Side-effects of topical steroids: A long overdue revisit. Indian Dermatol Online J. 2014;5(4):416.
- Rathi S, D′Souza P. Rational and ethical use of topical corticosteroids based on safety and efficacy. Indian J Dermatol. 2012;57(4):251.
- Taheri A, Cantrell J, Feldman SR. Tachyphylaxis to topical glucocorticoids; what is the evidence? Dermatol Online J. 2013;19(7):18954.
- Steinhoff M, Meinhardt A, Steinhoff A, Gemsa D, Bucala R, Bacher M. Evidence for a role of macrophage migration inhibitory factor in psoriatic skin disease. Br J Dermatol. 1999;141(6):1061–6.
- Lembo S, Capasso R, Balato A, Cirillo T, Flora F, Zappia V, et al. MCP- 1 in psoriatic patients: Effect of biological therapy. J Dermatolog Treat. 2014;25(1):83–6.
- Karbach S, Croxford AL, Oelze M, Schüler R, Minwegen D, Wegner J, et al. Interleukin 17 drives vascular inflammation, endothelial dysfunction, and arterial hypertension in psoriasis-like skin disease. Arter Thromb Vasc Biol. 2014;34(12):2658–68.
- Monfrecola G, Gaudiello F, Cirillo T, Fabbrocini G, Balato A, Lembo S. Nicotinamide downregulates gene expression of interleukin-6, interleukin-10, monocyte chemoattractant protein-1, and tumour necrosis factor-α gene expression in HaCaT keratinocytes after ultraviolet B irradiation. Clin Exp Dermatol. 2013;38(2):185–8.
- Weiss R, Schilling E, Grahnert A, Kölling V, Dorow J, Ceglarek U, et al. Nicotinamide: A vitamin able to shift macrophage differentiation toward macrophages with restricted inflammatory features. Innate Immun. 2015;21(8):813–26.
- Ungerstedt JS, Blombäck M, Söderström T. Nicotinamide is a potent inhibitor of proinflammatory cytokines. Clin Exp Immunol. 2003;131(1):48–52.
- Shi Y, Zhang L, Jiang R, Chen W, Zheng W, Chen L, et al. Protective effects of nicotinamide against acetaminophen-induced acute liver injury. Int Immunopharmacol. 2012:530–7.
- Larissa M, Lise Z, Siara Almeida Baptista T, Esteves Petersen L, Evandro Bauer M, Almeida Lopes Ungaretti C, et al. Subclinical atherogenesis in patients with mild psoriasis: A role for IL-6? Rev Assoc Med BRAs. 2017;63(9):747–52.
- Namazi M. Nicotinamide: a potential addition to the anti-psoriatic weaponry. FASEB J. 2003;17(11):1377–9.
- Fernandes CA, Fievez L, Ucakar B, Neyrinck AM, Fillee C, Huaux F, et al. Nicotinamide enhances apoptosis of G(M)-CSF-treated neutrophils and attenuates endotoxin induced airway inflammation in mice. Am J Physiol Lung Cell Mol Physiol. 2011;300(3):L354-61.
- Wiecher JW, Drenth BFH, Jonkman JHG, de Zeeuw RA. Percutaneous absorption of triamcinolone acetonide from creams with and without Azone®in humans in vivo. Int J Pharm. 1990;66(1–3):53–62.
- Schaefer H, Zesch A, Stüttgen G. Penetration, permeation, and absorption of triamcinolone acetonide in Normal and Psoriatic Skin. Arch Dermatological Res. 1977;258(3):241–9.
- Wolf R, Orion E, Ruocco E, Ruocco V. Abnormal epidermal barrier in the pathogenesis of psoriasis. Clin Dermatol. 2012:323–8.
- Uva L, Miguel D, Pinheiro C, Antunes J, Cruz D, Ferreira J, et al. Mechanisms of action of topical corticosteroids in psoriasis. Int J Endocrinol. 2012;2012:561018.
- Chen C-Y, Marrone G, He Z-H. Health Quality of Life and its associated factors for psoriasis patients in China: a cross-sectional study from hospital-based data. Karolinska Institutet, 2016.
- Eida A, Elweshahi H. Quality of life of Egyptian patients with psoriasis: a hospital based cross-sectional survey. Egypt J Dermatology Venerol. 2016;36(1):11.
- Lee YW, Park EJ, Kwon IH, Kim KH, Kim KJ. Impact of psoriasis on quality of life: Relationship between clinical response to therapy and change in health-related quality of life. Ann Dermatol. 2010;22(4):389–96.
- Patel T, Yosipovitch G. Therapy of pruritus. Expert Opin Pharmacother. 2010;11(10):1673–82.
Authors: Katrina Carmela M. Belen, MD, DPDS, Jasmin J.Jamora, MD, FPDS , Ma. Cecilia P. Ingente MD, DPDSAbstractBackground: Dermoscopy, a non-invasive diagnostic tool, has been proven to improve the diagnostic accuracy of vascular tumors since it can aid in...
A randomized, double-blind, comparative study on the safety and efficacy of virgin coconut (Cocos nucifera l.) oil against 1% hydrocortisone lotion as an anti-inflammatory and antipruritic preparation for mosquito reactions
Authors: Uy, Veronica S, MD; Gracia B. Teodosio, MD, FPDS; Ma. Teresita G. Gabriel, MD, FPDS; Mary Catherine T. Galang, MD; Mohammad Yoga A. Waskito, MD; Johannes F. Dayrit, MD, FPDS Abstract Background: Virgin coconut oil (VCO) has been reported...
Primary Cutaneous Anaplastic Large Cell Lymphoma (PC-ALCL) is a rare Non-Hodgkin lymphoma (NHL) representing approximately 9% of all cutaneous lymphomas.3 It usually manifests as a slow-growing, solitary tumor which has a tendency to regress spontaneously. However, metastasis is reported in 5-10% of cases.