Supplementary MaterialsSupplementary material 1 (PDF 201?kb) 13555_2015_68_MOESM1_ESM. combination items that contains salicylic acid Cd44 and corticosteroids. In the talked about trials, addition of INK 128 supplier salicylic acid was helpful in inducing a far more rapid starting point of action in addition to a reduced amount of intensity parameters and the area affected. However, its use has substantial limitations in young children, in individuals INK 128 supplier with renal/hepatic impairment, with widespread psoriasis, those undergoing phototherapy, or those concomitantly treated with calcipotriene/systemic salicylates. Conclusion In view of these shortcomings, there is a need for well-designed studies on suitable keratolytic alternatives to salicylic acid offering an indisputable positive benefitCrisk ratio. Electronic supplementary material The online version of this article (doi:10.1007/s13555-015-0068-3) contains supplementary material, which is available to authorized users. Local Psoriasis Severity Index, transepidermal water loss Urea Urea is known to exert proteolytic, keratolytic, hydrating, hygroscopic, penetration-enhancing, epidermis-thinning, and anti-pruritic effects. The moisturizing action of urea in dry and scaly pores and skin conditions has been widely studied and is definitely well approved [21, 38]. Fluhr et al.  suggested that lipid biosynthesis may be improved by topical software of highly concentrated urea. In vitro and in vivo data showed a reduction of DNA synthesis in the cells of the basal layers (by approximately 45%), a thinning of the epidermis (by approximately 20%), a reduction of the epidermal cells, and a prolongation of the generation time of postmitotic epidermal cells [21, 39]. Consequently, urea offers been shown to reduce epidermal hyperproliferation and to induce cell differentiation . As a mechanism of action it has been hypothesized that urea may break hydrogen bonds and interfere with the quaternary structure of keratin therefore dispersing and denaturizing keratin without disrupting the epidermal water barrier. Pre-treatment or concomitant treatment with urea may also enhance the efficacy of additional topical therapies . Due to its security, urea-containing preparations represent the standard in the adjuvant therapy of juvenile psoriasis . Only nonsystemic side effects have been reported, with moderate irritation becoming the most common, making urea a safe and well-tolerated topical drug . While a small, older comparative study found no statistical variations on severity parameters such as scaling, erythema, and infiltration compared to the vehicle , in another trial using the same planning, treatment for 1?week led to a statistically significant improvement of scaling compared to the vehicle (see Table?3) [38, 40C46]. This is in line with two further studies in which severity parameters of psoriasis such as scaling and/or induration were reduced with urea in monotherapy . Of these, in a small randomized, double-blind study, addition of 10% urea to the vehicle was significantly more effective regarding epidermal proliferation, stratum corneum hydration, and epidermal thickness with a 60% reduction of the medical psoriasis severity score of scaling and a 32% reduction of induration (observe Table?3) compared to the vehicle alone . The ointment foundation also improved psoriasis, but urea was significantly more effective showing a 40% reduction in epidermal proliferation compared to the vehicle . Similar results were demonstrated in a double-blind, placebo-controlled study, in INK 128 supplier which two urea gel formulations (10% simple urea gel or 5% urea niosomal gel) produced a reduction in erythema, infiltration, and desquamation, and also in the total psoriasis area and severity index (PASI) score, with the 5% urea niosomal gel becoming more effective regarding desquamation compared to the simple gel and placebo. However, the percentage of affected area was not influenced . From three small studies, limited evidence is known for an enhanced INK 128 supplier efficacy of additional topical agents such as bifonazole, dithranol or betamethasone dipropionate and calcipotriol leading to.