***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The synthetic compound MC 903 ( calcipotriol ) is a structural analogue of the naturally occurring , biologically active 1,25-dihydroxyvitamin D3 [ 1,25-(OH)2-D3 ] . MC 903 and 1,25-(OH)2-D3 show similar receptor binding and comparable effects on cell differentiation . However , MC 903 appears to be at least 100 times less potent in its effects on calcium metabolism . In previous double-blind placebo-controlled studies , topical MC 903 has been shown to have a therapeutic effect in psoriasis . The present open study involving 20 patients with psoriasis vulgaris was a right/left comparison of the efficacy and tolerability of MC 903 ointment ( 50 micrograms/g ) alone or with UVB radiation . After treatment for 8 weeks , topical MC 903 alone result ed in marked improvement in 66 % of the patients and in clearance in 17 % . Combination of topical MC 903 with UVB result ed in marked improvement in 50 % of the patients and in clearance in 39 % . These differences were not statistically significant . No significant change in serum calcium levels was detected . Two patients developed a facial dermatitis which disappeared spontaneously during continued treatment . These results show that the combination of topical MC 903 and UVB radiation is well tolerated . Larger-scale studies are warranted to answer the question whether UVB radiation induces a significant improvement of the antipsoriatic effect of topical MC 903 Summary Combining PUVA with other therapeutic agents which reduce the UVA dose required for clearance of psoriasis may be of benefit by reducing the long‐term risk of cutaneous malignancy and by increasing the efficacy of treatment . We have therefore studied the effect of calcipotriol in 13 patients with plaque‐type psoriasis who were about to start twice weekly PUVA . In each patient , from the start of PUVA treatment , two plaques on symmetrical body sites were selected for assessment . Calcipotriol ointment was applied to one twice daily , and placebo to the other . Response was assessed weekly for 6 weeks : an investigator , unaware of treatment allocation . compared psoriasis severity within each of the plaques , and blood flux was measured using a scanning laser‐Doppler velocimeter . Of the 11 patients who completed the study , in nine the calcipotriol‐treated plaque either cleared before the placebo‐treated plaque ( n=7 ) or was consistently judged to be better ( n = 2 ) . From the third week of the trial , mean blood flux was significantly lower in the calcipotriol‐treated plaques than in those treated with placebo . In the seven patients whose psoriasis was clear in at least one plaque at the end of the study period , there was a median reduction in UVA dose of 26·5 % for calcipotriol compared with placebo . With the exception of one patient , the improved response was not associated with earlier relapse BACKGROUND A narrow-b and UVB lamp ( Philips TL 01 ) emitting a peak of approximately 311 nm was developed to improve the phototherapy for psoriasis . Only a few studies have been performed with promising results . OBJECTIVE The therapeutic efficacy of the Philips TL 01 lamp in a new 100 W version was compared with conventional broad-b and lamps ( Sylvania UV 6 ) in a controlled trial . METHODS Twenty-three patients with psoriasis were treated with half-body exposures from the different UVB sources . The rate of clearing was monitored by estimation of the Psoriasis Area and Severity Index . All patients used emollients ; excessive scaling was removed with salicylic acid in yellow petrolatum . In 13 patients dithranol in a modified Ingram regimen was added . In most cases the study was discontinued once a difference between the two sides was evident . RESULTS In 20 of 23 cases the TL 01 lamp proved to be significantly more effective than the conventional source . Application of dithranol provided a substantial additional therapeutic effect . With the high-intensity TL 01/100W bulbs , exposure times were comparable to broad-b and UVB phototherapy . CONCLUSION The therapeutic efficacy of Philips TL 01/100W and its practicability for psoriasis phototherapy have been demonstrated BACKGROUND Recent advances in the treatment of psoriasis include both the topical vitamin D analogue calcipotriol and cyclosporine . Combined treatments have been sought to decrease the incidence of side effects while maintaining efficacy in the treatment of severe chronic plaque psoriasis . OBJECTIVE The objective of this study was to evaluate the efficacy and safety of the combination of 2 mg/kg/day of cyclosporine with calcipotriol ointment ( 50 micrograms/gm ) in the treatment of severe plaque psoriasis . METHODS Sixty-nine patients were r and omly selected for this double-blind , multicenter study to receive cyclosporine ( 2 mg/kg/day ) combined with calcipotriol ointment ( 50 micrograms/gm ) or cyclosporine ( 2 mg/kg/day ) combined with placebo ointment ( vehicle of calcipotriol ) for a 6-week period . RESULTS Complete clearing or 90 % improvement in Psoriasis Area and Severity Index score occurred in 50.0 % of patients in the calcipotriol/cyclosporine group in comparison with 11.8 % of patients treated with placebo/cyclosporine ( p = 0.0019 ) . The confidence interval for the difference ranged from 17.8 % to 58.7 % . No difference was found between the two groups with respect to side effects . CONCLUSION The calcipotriol/cyclosporine combination was more effective than placebo/cyclosporine . Further studies are needed to establish the long-term efficacy and safety profile of this combination therapy OBJECTIVE The aim of this study was to evaluate the efficacy and tolerability of the association of calcipotriol ointment ( 50 micrograms/g ) plus cyclosporine versus cyclosporine alone in the treatment of moderate psoriasis ( mean PASI : 13 ) . METHODS Twenty patients were enrolled in this right-left open study . All the patients admitted were treated with cylosporine at an initial dose of 4.5 mg/kg/day ; in case of clinical improvement this dosage was reduced by 0.5 mg/kg/day every 15 days . In each patient we chose two similar , symmetrical lesions and calcipotriol ointment was applied only on the right lesion , twice a day , until the healing of the lesion or for 1 month . Patients were checked at baseline and every 15 days . RESULTS Eighteen patients completed the study and 17 of the 18 presented more evident improvement on the side treated with combined therapy , while only one patient showed a better result on the side treated with cyclosporine alone . A significant difference of the total score was already present after 15 days of therapy and was confirmed at the following check-ups . CONCLUSIONS These results underline the usefulness of the association of calcipotriol and cyclosporine in order to decrease the total dosage of cyclosporine Ro 10 - 9359 is a retinoic acid derivative , selected for study because of a better tolerance than retinoic acid , shown in animal experiments . Doses of 25 mg b.i.d . , 25 mg t.i.d . and 50 mg b.i.d . were administered orally to 27 patients suffering from severe chronic generalized psoriasis . The clinical efficacy was evaluated by means of a new index , psoriasis area and severity index ( PASI ) based on severity and area of psoriatic lesions . At doses of 25 mg t.i.d . or 50 mg b.i.d . Ro 10 - -9359 proved to be an extremely potent antipsoriatic drug . A more than 90 % reduction of psoriatic lesions could be seen in 10 patients out of 20 after 4 - 8 weeks of treatment . This good effect lasted about 5 weeks after treatment . Side effects were frequent , but mostly mild and completely reversible after termination of treatment Eighteen patients with symmetric plaque-type psoriasis were recruited for an open , controlled , bilateral half-body comparison study to evaluate the efficacy of calcipotriol/tar/UVB vs. anthralin/tar/UVB in a day care treatment setting . No patient had been on systemic antipsoriatic agents for at least 3 months prior to enrolment . One half-body was arbitrarily assigned to treatment with gradually increasing concentrations of anthralin as tolerated . The other half-body received calcipotriol ointment twice daily . Both sides received UVB and additional coal tar distillate in accordance with our st and ard day care regimen . Patients who were admitted to the day care program attended the clinic for UVB , anthralin , and calcipotriol on weekdays for two consecutive weeks . Anthralin was applied to psoriatic plaques on one side in the following fashion : anthralin 0.1 % with salicylic acid 3 % in zinc oxide paste on days 1 and 2 ; anthralin 0.2 % with salicylic acid 3 % in zinc oxide paste on days 3 - 5 ; anthralin 1 % with salicylic acid 3 % in hydrophilic petrolatum for 60 min on days 8 - 10 to thicker lesions ; and anthralin 2 % with salicylic acid 3 % in hydrophilic petrolatum for 60 min on day 11 to thicker lesions . On the contralateral side , calcipotriol ointment 0.05 microgram/mL ( Leo Pharmaceuticals , Ajax , Ontario ) was applied to lesions twice daily . No  anthralin or calcipotriol  was applied on weekends . All patients applied coal tar oil 50 % ( Doak Oil Forte , Trans CanaDerm , St-Laurent , Québec , equivalent to 5 % coal tar distillate ) with salicylic acid 5 % in hydrophilic petrolatum to their lesions at home in the evenings and on weekends . UVB ( FSX72T12 lamps , National Biologic Corporation , Twinsburg , Ohio ) was administered twice daily on weekdays in increasing doses as tolerated ( to erythema ) prior to the application of the topical medications . No trial medications were applied to the face , scalp , or genital regions . For clinical evaluation , the st and ard Psoriasis Activity and Severity Index ( PASI ) score was modified by splitting the score for area under 10 % ; the modified score ( mPASI ) for an area of coverage of 1%-4 % was 0.5 and for an area of 5%-9 % was 1 . The head and neck area was excluded from the analysis since neither anthralin nor calcipotriol was used at these sites . Each half-body was considered to represent 100 % in the area score determination . The maximum modified score for each side was 64.8 ( vs. 72 in the st and ard PASI scoring system ) . Clinical evaluations were completed at days 0 ( baseline ) , 3 , 7 , 10 , and 42 . The primary end-point was day 10 . On day 10 , patients were asked to compare the calcipotriol ointment to the anthralin on a five-point scale in terms of efficacy and irritancy and to state their future preferred treatment modality . Following discharge from day care , patients were continued on outpatient UVB and tar treatments three times weekly and asked to return for a repeat clinical assessment after 4 weeks ( day 42 ) . Blood sample s taken prior to treatment and at day 10 were analyzed for serum calcium . Comparisons of treatment efficacy were based on changes in the mPASI scores from onset of treatment to day 10 , as well as on the corresponding percentage changes . Analyses were carried out using the Wilcoxon test . Subjective patient comparisons of effectiveness and irritancy , as well as patient preference , were tested for equiprobability using the chi-square goodness-of-fit test with an examination of the adjusted residuals A total of 20 patients with symmetric plaque-type psoriasis were recruited for a controlled , investigator-blinded , right-left study . None of the patients had used any therapy other than emollients for 2 months prior to starting in the trial . All patients had a negative antinuclear antibody . By history , all patients had previously improved upon exposure to sunlight or ultraviolet light . Two symmetrical sites of equal severity were selected as target areas . Each patient was treated on one side with mineral oil twice daily and on the opposite side with calcipotriene 0.005 % ointment twice daily . The investigator was blinded as to which site received which topical treatment . Both sides were treated with equal doses of ultraviolet B ( UVB ) three times weekly in graduated suberythemogenic doses . Ultraviolet B radiation was emitted by a group of 6-ft fluorescent bulbs ( Light Sources FS72 T12 UVB HO ) in a st and ard phototherapy unit . The above regimen was continued for a total of 12 weeks . The severity of psoriasis in the target sites was rated by the examiner at baseline and at weekly intervals for the 12 weeks of study . Target sites were rated by severity of erythema , scaling , plaque elevation , and pruritus , with each of these parameters being assigned a score on a four-point scale : 0 , clear ; 1 , mild ; 2 , moderate ; 3 , severe . The four scores were added together to arrive at a total severity score for each of the target sites . Statistical analysis was performed using the paired t test , P values less than 0.05 were considered statistically significant . Eleven of the 20 patients ( 55 % ) 
    Output:
    
RESULTS Antipsoriatic effects of acitretin , cyclosporine , and psoralen-UV-A phototherapy were enhanced with the addition of topical calcipotriene using the Psoriasis Area and Severity Index as the outcome , but this is not translated into an increase in the number of patients who achieve at least marked improvement .
There is limited evidence that use of calcipotriene might reduce the cumulative exposure to phototherapy and systemic treatment .
Overall , there is insufficient evidence to support any large effects in favor of combination treatment .
In the patient assessment s , the results do not show an adjuvant effect , but there is some evidence that use of calcipotriene might reduce cumulative exposure to systemic therapy to obtain clearance .
There were no long-term morbidity data on the effectiveness of any of the combinations studied .