Case 1: Cal/BD aerosol foam in mild-to-moderate psoriasis after previous treatment with a class 3 topical corticosteroid with vitamin D3 analog
A 72-year-old male had had plaque psoriasis for 15 years. He had classic psoriasis-related symptoms and was receiving tamsulosin 0.4 mg/day for benign prostatic hyperplasia. He had previously been treated with topical Cal 50 microg/g and betamethasone 0.5 mg/g ointment (2009-2010), methotrexate (2009-2013), and ustekinumab (2015-2017).
Physical examination revealed recalcitrant psoriasis, principally on the lower trunk and gluteal regions (Figure 1A). Psoriasis Area Severity Index (PASI) score at presentation was 5.5, and in February 2018, the patient started treatment with daily application of Cal/BD aerosol foam, which was continued for 4 weeks.
After 4 weeks' treatment, the psoriatic lesions had markedly improved (Figure 1B) and PASI score had decreased to 1.5. The patient was very satisfied with treatment, and the need for systemic therapy was avoided.
Case 2: Cal/BD aerosol foam in mild-to-moderate psoriasis after a long history of systemic therapy, PUVA, and topical drugs
A 72-year-old male had a 25-year history of psoriasis. He had classic psoriasis-related symptoms and was receiving atorvastatin for hypercholesterolemia, losartan and bendroflumethiazide for hypertension, and prophylactic clopidogrel for stroke. He had previously received 80 sessions of PUVA, eight courses of UVB, many years of acitretin therapy, and various topical treatments, including Cal/betamethasone and clobetasol. Acitretin therapy was stopped in March 2016, with the hope of controlling the psoriasis without systemic therapy. The patient was keen to try a new treatment.
Physical examination at presentation revealed recalcitrant psoriasis on the backs of the hands (Figure 2A), buttocks, and thigh. The patient was particularly troubled by the psoriasis on the back of his hands, which had shown no improvement, even during acitretin treatment. PASI score at presentation was 6.2, and in April 2017, the patient started treatment with daily application of Cal/BD aerosol foam, which was continued for 4 weeks.
After 4 weeks' treatment, the psoriatic lesions had markedly improved (Figure 2B) and PASI score had decreased to 2.0. The patient was very satisfied with Cal/BD aerosol foam, with the overall perception of particular efficacy for psoriasis on the back of his hands and no requirement for systemic therapy.
Case 3: Cal/BD aerosol foam after previous treatment with class 4 topical corticosteroids
A 71-year-old male had a history of psoriasis, which had originally been diagnosed at the age of 30 years; however, throughout his life, the patient had also experienced remissions. Previous treatment had included various topical medications, such as mometasone furoate and clobetasol ointments, and narrowband UVB. The patient was receiving atorvastatin for hypercholesterolemia and omeprazole for dyspepsia.
Physical examination at presentation revealed hyper-keratotic psoriatic plaques on the legs and elbows, and the patient was especially troubled by psoriasis on the anterior legs (Figure 3A). PASI score at presentation was 7.2, and the patient started treatment with once-daily application of Cal/BD aerosol foam for 4 weeks.
After 4 weeks of treatment, the patient's psoriasis was less distinctive and less keratotic (Figure 3B), PASI score had decreased to 3.2, and the patient was satisfied with the treatment outcome.
Case 4: An unsatisfied patient with a long history of using different topical therapies who switched to cal/BD aerosol foam
A 35-year-old male had experienced chronic recurrent psoriasis since early adulthood but without attendant joint pain. Previous treatment had included systemic therapy with fumaric acid esters a few years earlier, but this had to be discontinued because of tolerability issues. The patient had used several topical treatments, such as mometasone and betamethasone ointments, and various skin care preparations, but without success. Most recently, the patient had used topical Cal/betamethasone ointment once daily, but no significant skin improvement was attained. The patient was also dissatisfied with the fatty consistency of the ointment. He had reported no significant previous illnesses, other than mild allergic rhinitis and lipomatosis.
Physical examination at presentation revealed classic psoriatic plaques, each about 3-4 cm in diameter, on the elbows and knees, and on the posterior thigh (Figure 4A). PASI score at presentation was 4.8, BSA involvement was 5%, and the patient started treatment with once-daily application of Cal/BD aerosol foam.
After only 1 week of Cal/BD application, reddening and infiltration of the plaques had significantly decreased (Figure 4B); pruritus had also completely subsided within the first week of treatment. After 4 weeks' application, most of the plaques had completely healed and existing residual lesions showed only minimal erythema without signs of infiltration or desquamation. The PASI score had decreased to 0.8. The patient was satisfied with Cal/BD aerosol foam treatment, particularly the fast retraction of the foam.
Case 5: Cal/BD aerosol foam in moderate-to-severe psoriasis after previous treatment with oral systemic therapy
A 56-year-old male had had psoriasis for 2 years. A family history was evident, as the patient's father also had psoriasis. The patient's PASI score was 12, DLQI score was 14, and the patient had approximately 13% BSA affected (Figure 5A). Previously, the patient had been treated unsuccessfully with topical corticosteroids, UVB phototherapy, and methotrexate.
Because PASI and BSA scores were >10, and previous systemic therapy with methotrexate was unsuccessful, the option of biologic therapy was introduced to, and discussed thoroughly with, the patient. Consequently, biologic drug prescreening (chest X-ray, QuantiFERON-TB [Qiagen NV, Venlo, the Netherlands], and hepatitis and HIV serology) was undertaken. Meanwhile, because of considerable pruritus in the elbow and lower extremity regions, topical therapy was started with Cal/BD aerosol foam.
After 2 weeks' application of Cal/BD foam, a significant clinical response (PASI75) and an improvement of itching were attained (Figure 5B). The patient reported that Cal/BD foam was easy and convenient to apply and was very satisfied with the clinical response particularly the fact that his itch had completely disappeared after a few days. Subsequently, after exclusion of tuberculosis, hepatitis, and HIV infection, biologic therapy was started and concurrent Cal/BD aerosol foam was continued for a further 2 weeks.