La terapia de combinación: un recurso para diferentes dermatosis
Palabras clave:
psoriasis, combinación, terapia, pénfigo, dermatitis atópica, vitiligo, linfomas cutáneosResumen
La terapia de combinación se define como el uso de 2 ó más agentes terapéuticos, logrando beneficio de ambos, disminuyendo la dosis y a menudo los efectos secundarios. Se hace una revisión de la literatura médica en los últimos cinco años, de estudios multicéntricos controlados o, en su defecto, revisiones importantes de terapias combinadas novedosas en diferentes enfermedades cutáneas.
Psoriasis fue la enfermedad en la que se obtuvo mayor información respecto a esta forma de terapia. El uso tópico combinado de calcipotriol, o el tazaroteno con otras drogas ha sido objeto de muchos estudios. También es frecuente, en esta enfermedad, el uso de dos o más drogas sistémicas, de manera simultánea, secuencial o rotacional.
Dentro del grupo de enfermedades ampollosas, principalmente en el pénfigo, se han utilizado diferentes combinaciones con los córticoesteroides, que han aumentado la sobrevida.
Finalmente, otras dermatosis como los linfomas cutáneos, la dermatitis atópica, el vitiligo y el acné, se han beneficiado de la combinación de drogas.
Biografía del autor/a
Angela Zuluaga de Cadena, Instituto de Ciencias de la Salud, CES
Jefe Dermatología Instituto de Ciencias de la Salud (CES), Medellín.
Referencias bibliográficas
1. Roenigk HH. Acitretin combination therapy. J Am Acad Dermatol 1999; 4:S18-21.
https://doi.org/10.1016/S0190-9622(99)70361-0
2. Lebwohl M. The role of salycilic acid in the treatment of psoriasis. lnt J Dermat 1999; 38: 1624.
https://doi.org/10.1046/j.1365-4362.1999.00500.x
3. Patel B, Siskin S, Krazmien R, et al. Compatibility of calcipotriene with other topical medications. J Am Acad Dermatol 1998; 38:1010-1011.
https://doi.org/10.1016/S0190-9622(98)70171-9
4. Ruzicka T, Lorenz B. Comparison of calcipotriol monotherapy and a combination of calcipotriol and betamethasone valerate after 2 weeks' treatment with calcipotriol in the topical therapy of psoriasis vulgar: a multicentre, double-blind, randomized study. Br J Dermatol 1998; 138:254-258.
https://doi.org/10.1046/j.1365-2133.1998.02070.x
5. Singh S, Shekhar Reddy DC, Pandey SS. Topical therapy for psoriasis with the use of augmented betamethasone and calcipotriene on alternate weeks. J Am Acad Dermatol 2000; 43:61-65.
https://doi.org/10.1067/mjd.2000.105167
6. Feldman SR, Fleischer AB, Cooper JZ. New topical treatments change the pattern of treatment of psoriasis: dermatologist remain the primary providers of this care. lnt J Dermat 2000; 39:41-44.
https://doi.org/10.1046/j.1365-4362.2000.00878.x
7. Hecker D, Worsley J, Yueh G. In vitro compatibility of tazarotene with other topical treatments of psoriasis. J Am Acad Dermatol 2000; 42: 1008-1011.
https://doi.org/10.1067/mjd.2000.104304
8. Lebwohl M, Breneman DL, Goffe BS, et al. Tazarotene 0.1 % gel plus corticosteroid cream in the treatment of plaque psoriasis. J Am Acad Dermatol 1998; 39:590-596.
https://doi.org/10.1016/S0190-9622(98)70008-8
9. Hecker D, Worsley J, Yueh G, et al. lnteractions between tazarotene and ultraviolet light. J Am Acad Dermatol 1999; 41 :927-930.
https://doi.org/10.1016/S0190-9622(99)70248-3
10. Guenther L. Tazarotene combination treatments in psoriasis. J Am Acad Dermatol 2000; 43:S36-42.
https://doi.org/10.1067/mjd.2000.108320
11. Lebwohl M. Strategies to optimize efficacy, duration of remission, and safety in the treatment of plaque psoriasis by using tazarotene in combination with corticosteroid. J Am Acad Dermatol 2000; 43:S43-46.
https://doi.org/10.1067/mjd.2000.108319
12. Lebwohl M. Acitretin in combination with UVB or PUVA. J Am Acad Dermatol 1999; 41 :S22-24.
https://doi.org/10.1016/S0190-9622(99)70362-2
13. Koo J. Systemic sequential therapy of psoriasis: A new paradigm for improved therapeutic results. J Am Acad Dermatol 1999; 41 :S25-28.
https://doi.org/10.1016/S0190-9622(99)70363-4
14. Lebwohl M. Advances in psoriasis Therapy. Dermatol Clinics 2000; 18:13-19.
https://doi.org/10.1016/S0733-8635(05)70142-X
15. Calebotta A, Sáenz AM, González F, et al. Pemphigus vulgaris: benefits of tetracycline as adjuvant therapy in a series of thirteen patients. lnt J Dermat 1999; 38:217-221.
https://doi.org/10.1046/j.1365-4362.1999.00624.x
16. Robinson JC, Lozada-Nur F, Frieden L, et al. Oral pemphigus vulgaris. A review of the literature and a report on the management of 12 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 84:349-355.
https://doi.org/10.1016/S1079-2104(97)90030-5
17. loannides D, Chrysomallis F, Bystryn JC. lneffective-ness of Cyclosporine as an adjuvant to Corticoster-oids in the treament of pemphigus. Arch Dermatol 2000; 136:868-872.
https://doi.org/10.1001/archderm.136.7.868
18. Carson PJ, Hameed A, Ahmed R. lnfluence of treatment on the clinical course of pemphigus vulgaris. J Am Acad Dermatol 1996; 34:645-652.
https://doi.org/10.1016/S0190-9622(96)80066-1
19. Bystryn JC, Steinman NM. The adyuvant therapy of pemphigus. An update adjuvant to Corticosteroids in the treament of pemphigus. Arch Dermat 1996; 132:203-212.
https://doi.org/10.1001/archderm.1996.03890260105016
20. Korman NJ. New and emerging therapies in the treatment of blistering diseases. Dermatol Clinics 2000; 18:127-137.
https://doi.org/10.1016/S0733-8635(05)70153-4
21. Stadler R, Otte HG, Luger T, et al. Prospective randomized multicenter clinical trial on the use of interferon alfa 2a plus acitretin versus inte·rteron alfa 2a plus PUVA in patients with cutaneous T-cell lynphomas stages I and 11. Blood 1998; 92:3578-3581.
22. Wilson LD, Jones GW, Kim D, et al. Experience with total skin electron beam therapy in combination with extracorporeal photopheresis in the mangement of patients with erythrodermic (T4) mycosis fungoides. J Am Acad Dermatol 2000; 43:54-60.
https://doi.org/10.1067/mjd.2000.105510
23. Jewell ML, McCauliffe DP. Patients with cutaneous lupus erythematosus who smoke are less responsive to antimalarial treatment. J Am Acad Dermatol 2000; 42:983-987.
https://doi.org/10.1067/mjd.2000.103635
24. Berberian BJ, Breneman DL, Drake LA, et al. The addition of topical doxepin to corticosteroid therapy: an improved treatment regimen for atopic dermatitis. lnt J Dermatol 1999; 38: 145-148.
https://doi.org/10.1046/j.1365-4362.1999.00505.x
25. Westerhof W, Nieuweboer-Krobotova L, Mulder PGH, et al. Left-right comparison study of the combination of fluticasone and UV-A vs. either fluticasone propionate or UV-A alone for the long-term treatment of vitiligo. Arch Dermatol 1999; 135: 1061-1066.
https://doi.org/10.1001/archderm.135.9.1061
26. Beutner KR, Ferenczy A. Therapeutic approaches to genital warts. Am J Med 1997; 102:28-37.
https://doi.org/10.1016/S0002-9343(97)00181-2
27. Webster G. Combination azelaic acid therapy for acne vulgaris. J Am Acad Dermatol 2000; 43:S47-50.
https://doi.org/10.1067/mjd.2000.108318
https://doi.org/10.1016/S0190-9622(99)70361-0
2. Lebwohl M. The role of salycilic acid in the treatment of psoriasis. lnt J Dermat 1999; 38: 1624.
https://doi.org/10.1046/j.1365-4362.1999.00500.x
3. Patel B, Siskin S, Krazmien R, et al. Compatibility of calcipotriene with other topical medications. J Am Acad Dermatol 1998; 38:1010-1011.
https://doi.org/10.1016/S0190-9622(98)70171-9
4. Ruzicka T, Lorenz B. Comparison of calcipotriol monotherapy and a combination of calcipotriol and betamethasone valerate after 2 weeks' treatment with calcipotriol in the topical therapy of psoriasis vulgar: a multicentre, double-blind, randomized study. Br J Dermatol 1998; 138:254-258.
https://doi.org/10.1046/j.1365-2133.1998.02070.x
5. Singh S, Shekhar Reddy DC, Pandey SS. Topical therapy for psoriasis with the use of augmented betamethasone and calcipotriene on alternate weeks. J Am Acad Dermatol 2000; 43:61-65.
https://doi.org/10.1067/mjd.2000.105167
6. Feldman SR, Fleischer AB, Cooper JZ. New topical treatments change the pattern of treatment of psoriasis: dermatologist remain the primary providers of this care. lnt J Dermat 2000; 39:41-44.
https://doi.org/10.1046/j.1365-4362.2000.00878.x
7. Hecker D, Worsley J, Yueh G. In vitro compatibility of tazarotene with other topical treatments of psoriasis. J Am Acad Dermatol 2000; 42: 1008-1011.
https://doi.org/10.1067/mjd.2000.104304
8. Lebwohl M, Breneman DL, Goffe BS, et al. Tazarotene 0.1 % gel plus corticosteroid cream in the treatment of plaque psoriasis. J Am Acad Dermatol 1998; 39:590-596.
https://doi.org/10.1016/S0190-9622(98)70008-8
9. Hecker D, Worsley J, Yueh G, et al. lnteractions between tazarotene and ultraviolet light. J Am Acad Dermatol 1999; 41 :927-930.
https://doi.org/10.1016/S0190-9622(99)70248-3
10. Guenther L. Tazarotene combination treatments in psoriasis. J Am Acad Dermatol 2000; 43:S36-42.
https://doi.org/10.1067/mjd.2000.108320
11. Lebwohl M. Strategies to optimize efficacy, duration of remission, and safety in the treatment of plaque psoriasis by using tazarotene in combination with corticosteroid. J Am Acad Dermatol 2000; 43:S43-46.
https://doi.org/10.1067/mjd.2000.108319
12. Lebwohl M. Acitretin in combination with UVB or PUVA. J Am Acad Dermatol 1999; 41 :S22-24.
https://doi.org/10.1016/S0190-9622(99)70362-2
13. Koo J. Systemic sequential therapy of psoriasis: A new paradigm for improved therapeutic results. J Am Acad Dermatol 1999; 41 :S25-28.
https://doi.org/10.1016/S0190-9622(99)70363-4
14. Lebwohl M. Advances in psoriasis Therapy. Dermatol Clinics 2000; 18:13-19.
https://doi.org/10.1016/S0733-8635(05)70142-X
15. Calebotta A, Sáenz AM, González F, et al. Pemphigus vulgaris: benefits of tetracycline as adjuvant therapy in a series of thirteen patients. lnt J Dermat 1999; 38:217-221.
https://doi.org/10.1046/j.1365-4362.1999.00624.x
16. Robinson JC, Lozada-Nur F, Frieden L, et al. Oral pemphigus vulgaris. A review of the literature and a report on the management of 12 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 84:349-355.
https://doi.org/10.1016/S1079-2104(97)90030-5
17. loannides D, Chrysomallis F, Bystryn JC. lneffective-ness of Cyclosporine as an adjuvant to Corticoster-oids in the treament of pemphigus. Arch Dermatol 2000; 136:868-872.
https://doi.org/10.1001/archderm.136.7.868
18. Carson PJ, Hameed A, Ahmed R. lnfluence of treatment on the clinical course of pemphigus vulgaris. J Am Acad Dermatol 1996; 34:645-652.
https://doi.org/10.1016/S0190-9622(96)80066-1
19. Bystryn JC, Steinman NM. The adyuvant therapy of pemphigus. An update adjuvant to Corticosteroids in the treament of pemphigus. Arch Dermat 1996; 132:203-212.
https://doi.org/10.1001/archderm.1996.03890260105016
20. Korman NJ. New and emerging therapies in the treatment of blistering diseases. Dermatol Clinics 2000; 18:127-137.
https://doi.org/10.1016/S0733-8635(05)70153-4
21. Stadler R, Otte HG, Luger T, et al. Prospective randomized multicenter clinical trial on the use of interferon alfa 2a plus acitretin versus inte·rteron alfa 2a plus PUVA in patients with cutaneous T-cell lynphomas stages I and 11. Blood 1998; 92:3578-3581.
22. Wilson LD, Jones GW, Kim D, et al. Experience with total skin electron beam therapy in combination with extracorporeal photopheresis in the mangement of patients with erythrodermic (T4) mycosis fungoides. J Am Acad Dermatol 2000; 43:54-60.
https://doi.org/10.1067/mjd.2000.105510
23. Jewell ML, McCauliffe DP. Patients with cutaneous lupus erythematosus who smoke are less responsive to antimalarial treatment. J Am Acad Dermatol 2000; 42:983-987.
https://doi.org/10.1067/mjd.2000.103635
24. Berberian BJ, Breneman DL, Drake LA, et al. The addition of topical doxepin to corticosteroid therapy: an improved treatment regimen for atopic dermatitis. lnt J Dermatol 1999; 38: 145-148.
https://doi.org/10.1046/j.1365-4362.1999.00505.x
25. Westerhof W, Nieuweboer-Krobotova L, Mulder PGH, et al. Left-right comparison study of the combination of fluticasone and UV-A vs. either fluticasone propionate or UV-A alone for the long-term treatment of vitiligo. Arch Dermatol 1999; 135: 1061-1066.
https://doi.org/10.1001/archderm.135.9.1061
26. Beutner KR, Ferenczy A. Therapeutic approaches to genital warts. Am J Med 1997; 102:28-37.
https://doi.org/10.1016/S0002-9343(97)00181-2
27. Webster G. Combination azelaic acid therapy for acne vulgaris. J Am Acad Dermatol 2000; 43:S47-50.
https://doi.org/10.1067/mjd.2000.108318
Cómo citar
1.
Zuluaga de Cadena A. La terapia de combinación: un recurso para diferentes dermatosis. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 1 de julio de 2001 [citado 20 de abril de 2024];9(2):511-8. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/828
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2001-07-01
Cómo citar
1.
Zuluaga de Cadena A. La terapia de combinación: un recurso para diferentes dermatosis. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 1 de julio de 2001 [citado 20 de abril de 2024];9(2):511-8. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/828
Número
Sección
Terapéutica
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