Background The scalp is a common area for plaque psoriasis. Corticosteroid‐based lotions are the most widely used therapy in this clinical setting. A new formulation of betamethasone valerate 0·12% in a thermophobic, low‐residue foam vehicle (Bettamousse™, Mipharm, Italy; BVM) is available for the treatment of scalp dermatoses.

Objectives In an open, investigator‐blinded, multicentre (28 dermatology clinics), randomized, cross‐over study, the efficacy, safety and patient acceptability of BVM in scalp psoriasis were evaluated in comparison with standard therapies (ST, i.e. corticosteroids or vitamin D analogues). ST were chosen by each centre according to its usual therapeutic protocols.

Methods In total, 241 patients with moderate to severe scalp psoriasis participated in the trial. After a 2‐week run‐in period, each active treatment (BVM or ST) was applied for 4 weeks, with a wash‐out period between the two active treatment phases of at least 4 weeks. Efficacy was evaluated by investigators unaware of treatment sequence analysing a ‘target’ lesion for erythema, scaling, itching and burning using a five‐point grading score. Patient treatment acceptability and assessment of the influence on Psoriasis Disability Index were evaluated using an eight‐item modified Finlay–Khan questionnaire at baseline and at the end of each treatment period. Safety was evaluated by recording any adverse event occurring during the study duration. BVM was applied twice daily, and ST were applied once or twice daily, according to the approved scheduled regimens.

Results Analyses were by intention‐to‐treat. Two hundred and ten patients concluded the study. Fifteen patients withdrew from the study during BVM treatment, and 16 during ST (not significantly different). Both treatments were well tolerated. At baseline, the mean ± SD clinical global score (the ‘Sum’ score = erythema + scaling + itching + burning) was 7·6 ± 2·6. The ST chosen were topical corticosteroids (55% of cases; mainly mometasone and betamethasone dipropionate) or calcipotriol lotion (45% of cases). At the end of active treatments, BVM was significantly superior to ST (P < 0·001) in reducing, as compared with baseline, the mean ± SD Sum score (1·5 ± 1·9 with BVM and 3·1 ± 2·7 with ST). During BVM treatment, 88% (95% confidence interval, CI 82–94%) of patients had a complete or nearly complete resolution of scaling in comparison with 66% (95% CI 58–74%) during ST therapy (P < 0·001). BVM was also considered an easier and more convenient formulation to use in comparison with ST (P < 0·01).

Conclusions BVM is more effective than lotion‐based ST commonly used in the treatment of scalp psoriasis, and has higher patient acceptability.