Efficacy and safety of systemic methotrexate vs. acitretin in psoriasis patients with significant palmoplantar involvement: a prospective, randomized study
- 16 October 2012
- journal article
- research article
- Published by Wiley in Journal of the European Academy of Dermatology and Venereology
- Vol. 27 (3), e384-e389
- https://doi.org/10.1111/jdv.12004
Abstract
Background Palmoplantar psoriasis (PP) is a chronic, inflammatory and proliferative dermatosis of the palms and/or soles with significant morbidity. It is notoriously difficult to treat and unresponsive to traditional topical agents. Material and methods This was a prospective, randomized study involving 111 patients of psoriasis with significant palmoplantar disease. Patients meeting the eligibility criteria were randomly assigned to one of the two treatment groups. Patients in Group I received methotrexate in doses of 0.4 mg/kg weekly, and patients in Group II received acitretin in doses of 0.5 mg/kg daily. Patients were evaluated by modified PPPASI (m‐PPPASI) score for palm and sole involvement at baseline, at two weekly intervals for the first 4 weeks and then four weekly for next 8 weeks. Treatment protocol was continued for a period till patient achieved 75% reduction in m‐PPPASI from baseline or 12 weeks whichever was earlier. Results There was a statistically significant difference in reduction of m‐PPPASI of patients on methotrexate at weeks 8 and 12. The mean m‐PPPASI at week 8 was 15.38 ± 6.08 in methotrexate group and 17.23 ± 5.25 in acitretin group (P = 0.04). The mean m‐PPPASI at week 12 was 10.30 ± 5.97 in methotrexate group and 12.40 ± 5.31 in acitretin group (P = 0.03). Marked improvement (m‐PPPASI 75) was achieved in 12 (24%) patients in methotrexate group compared with 4 (8%) in acitretin group which was statistically significant (P = 0.029). Adverse events were generally mild and were seen in 14 patients in methotrexate group and 15 patients in acitretin group (P = 0.080). Conclusion Methotrexate is relatively inexpensive, safe and efficacious drug for the treatment of psoriasis patients with significant palmoplantar involvement. Acitretin can be used as an alternative therapy and with a good safety profile.Keywords
This publication has 14 references indexed in Scilit:
- Psoriasis: characterization of six different clinical phenotypesExperimental Dermatology, 2009
- A retrospective analysis of treatment responses of palmoplantar psoriasis in 114 patientsJournal of the European Academy of Dermatology and Venereology, 2009
- Efalizumab for severe palmo‐plantar psoriasis: an open‐label pilot trial in five patientsJournal of the European Academy of Dermatology and Venereology, 2009
- Alefacept is Safe and Efficacious in the Treatment of Palmar Plantar PustulosisJournal of Cutaneous Medicine and Surgery, 2007
- Differential clinical response to alefacept in combination with methotrexate in two patients with refractory palmar psoriasisBritish Journal of Dermatology, 2007
- Treatment of palmoplantar psoriasis with monochromatic excimer light (308-nm) versus cream PUVAActa Dermato-Venereologica, 2006
- Retrospective analysis of the treatment of psoriasis of the palms and solesJournal of Dermatological Treatment, 2003
- Palmoplantar Lesions in Psoriasis: A Study of 3065 PatientsActa Dermato-Venereologica, 2002
- Acitretin therapy for palmoplantar pustulosis combined with UVA and topical 8-MOP.International Journal of Dermatology, 2001
- The Natural History of Psoriasis in 5,600 PatientsDermatology, 1974