Ed's Dovonex™ Trial
(April-May, 1998)

I tried Dovonex™ for the second time this year. From April 9 through May 22 I used about 180 grams of Dovonex™, averaging 9.09 grams applied daily in two applications (upon rising and upon going to bed). I reasoned that my first experience with Dovonex™ (1996) was "unfair" to the drug because I switched from a combination of two powerful corticosteroids (Diprolene™ and Temovate™) directly to the non-steroidal Dovonex™. Corticosteroids have been long known to cause psoriasis flare-ups with sudden discontinuance. Since that first trial, my topical steroids regimen had been adjusted to rotate me through powerful, to intermediate, then low potency topicals. On April 8 I finished my lowest potency topical period in the cycle—a tube of Westcort™ cream—so I had the least amount of steroids in my skin. I reasoned this was the best time to try Dovonex™, again.

Figure 1

About 65-70 percent of my known lesions were active (i.e., flaming) on April 9, which is not unusual at this "bottom end" period of my corticosteroid's cycle. Perhaps they were a little more active than usual because of the warming spring weather. (My flare ups are predictable with any change in climate.) Figure 1 is a graphic representation of my active lesions on April 9.

Figure 2

Figure 2 represents my lesion activity at 2 weeks into the trial. Lesions that showed improvement are represented in the graphic in a lighter color red. My front and back torso lesions, and the lesions on my elbows and knees, showed definite improvement. The lesions on my torso stopped flaking and their color was beginning to return to the normal skin color. Lesions that showed no improvement were on my hands, calves, feet and scalp. (I did not treat the scalp with Dovonex™.)

Even those lesions that showed no visible improvement in coloration were obviously affected by the Dovonex™. Twice daily applications tended to make the flakes less visible, less yellow/whitish. However, it appeared the flaky skin was still there, simply moist rather than dry. Rather than peeling off in flakes, this skin would "roll off," or come off with the slightest rubbing or scraping. This suggested to me the skin was not regenerating less quickly—the psoriasis was not subsiding—but something in the Dovonex was changing the characteristics of the dead surface layer of skin, making it more supple than the normal scaly, flaky skin.

This change in the nature of my flakes proved somewhat hazardous. I found that removing the usually flaky top layer of skin was easier and that it took very little rubbing or scraping to start the lesions bleeding.

As the trial progressed, there was never any diminishment in the crimson color of the calf, hands, wrist or feet lesions. These lesions continued to itch, though I can't say the itching worsened. However, while using the Dovonex™, if I scratched these lesions they were much more likely to bleed. About four weeks into the trial I gave up on the Dovonex on these resistant lesions and resumed use of Diprolene™. So, for the final two weeks of the trial I was using Dovonex™ on the lesions that had quieted and the corticosteroid on other lesions.

By the time I finished my second tube of Dovonex, the lesions it had improved appeared to plateau. They were still visible, but the discoloration was much diminished, they were neither flaking nor itching.

I discontinued the Dovonex™ after the second tube and resumed my previous cyclical regimen of corticosteroids. This decision was primarily an economic one. The lesions that were improved by the Dovonex™ were and are my least troublesome. My most troublesome lesions were changed by the Dovonex™, but not "improved" (in my mind, at least). Considering that the Dovonex™ is from 50-100 percent more expensive that the corticosteroids I had used previously, I determined that, for me, its value did not justify the cost. However, I would not hesitate to recommend mild to moderate psoriatics at least try Dovonex™, especially if itching (and scratching) is not a severe problem for them. -Ed