Comparative therapeutic evaluation of different topicals and narrow band ultraviolet B therapy combined with systemic methotrexate in the treatment of palmoplantar psoriasis

Abstract

Background:The incidence of uncomplicated psoriasis is 1–3% in the general population. The involvement of palm and sole is seen in 7–14.5% of cases. There are different topicals and systemic therapies available for treating the case of psoriasis but none is satisfactory for longer duration.Aim:The study involved the comparative therapeutic evaluation of the different topical regimens and narrow band ultraviolet B (NB-UVB) therapy in combination with systemic methotrexate.Materials and Methods:The study was held in out-patient department of Skin, VD and Leprosy of B.R.D. Medical College, Gorakhpur, from July 2007 to December 2008. The group included 98 new cases of palmoplantar psoriasis. These cases were divided into eight groups according to the eight regimens involved in the study. The severity of psoriasis was assessed by the ESIF (erythema, scaling, induration and fissuring) score.Results:The study showed that all the regimens had significant response rates. The combination of NB-UVB with systemic methotrexate had maximum response rate (64.85±4.52%) that was statistically significant (paired “t” at 16d.f. = 33.329, P<0.001) with minimum number of recurrences after stopping the treatment. The combination of halobetasol ointment with systemic methotrexate also had significant response rate (paired “t” at 19d.f. = 13.5183, P<0.001) but had maximum number of cases with recurrence (70%) after stopping the treatment.Conclusion:These results suggest that the combination of every regimen with systemic methotrexate resulted in an early and a good improvement in the quality of life of patients suffering from psoriasis. It also shows that NB-UVB in combination with systemic methotrexate is more efficacious and has minimum recurrence rate and side effects in the treatment of palmoplantar psoriasis.

Pattern of drug use in the management of psoriasis in a tertiary care hospital: a prospective study

“…Similar pattern of triple therapy has been reported in several other studies, but considered only for those cases with baseline PASI score >10. 6,[16][17][18]21,22 In GC monotherapy used as clobetasol, halobetasol and betamethsone (n=66), the decrease in the mean baseline score was 91.03%, which was highly significant (p<0.001). In patients treated with GC + SA (n=15), the decrease after 12 weeks of therapy was 82.73%.…”

“…The baseline PASI score recorded was in accordance with other studies, which have also observed that majority of the patients had less severe lesions with PASI <10. [6][7][8][9]11,16,17 Most of the patients (n=95; 78.51%) were treated with topical medications, which included GC, SA, calcitriol and coal tar, either as monotherapy or in combination of two or more drugs, in the form of creams or ointments. Clobetasol and halobetasol are the most potent topical steroids preferred in psoriasis for their anti-inflammatory and antiproliferative action.…”

“…Among the GCs, clobetasol was used in majority of the cases. 5,6,16,17,[19][20][21] Systemic therapy with oral Mtx 7.5 mg once weekly, supplemented with folic acid, was used in eight patients (6.61%) with severe chronic plaque psoriasis with base line PASI score >7, in combination with topical therapy. Topical therapy included GCs as monotherapy in five patients, GC + calcitriol + SA in one patient, GC + calctriol in one patient and GC + SA in one patient.…”

Palmoplantar Psoriasis Successfully Treated with Raw Natural Honey: A Case Report

“…According to a systematic review by Li l et al 16 current topical treatments including laser therapy, tazarotene ointment and methotrexate gel apart from phototherapy do not have sufficient evidence to justify their use. None theless, phototherapy needs to be administered over a long treatment period, around 21.9 months before noticeable improvements can be seen, 17 it also causes erythema, irritation and burning. 16,17,18 Topical methotrexate has been advocated as an adequate alternative to systemic side effects with less adverse effects.…”

“…None theless, phototherapy needs to be administered over a long treatment period, around 21.9 months before noticeable improvements can be seen, 17 it also causes erythema, irritation and burning. 16,17,18 Topical methotrexate has been advocated as an adequate alternative to systemic side effects with less adverse effects. 19 However, a small prospective, open label study involving fourteen patients showed variable results by Kumar et al 20 Similar to PUVA various side effects have been reported with topical methotrexate including redness, burning sensation, purpura and blisters at the site of application.…”