Comparative study of oral methotrexate and acitretin in the treatment of palmoplantar psoriasis
Keywords:Psoriasis, Palms and soles, Quality of life, Immunosuppressive agents
Background:Psoriasis is chronic inflammatory skin condition. Palmoplantar psoriasis is a type where lesions are present on the palms and soles. This type affects patient’s quality of life and is difficult to treat. Topical modes of treatment are not so effective and produce inadequate response. Systemic drugs are necessary in the treatment of moderate to severe disease. The objective was to compare the efficacy of oral methotrexate and acitretin in treatment of moderate to severe palmoplantar psoriasis and there side effects.
Methods:50 patients with palmoplantar psoriasis were randomized into 2 groups. Patients in group I received oral methotrexate and patients in group II received acitretin for 3 months. Baseline grading was done with Modified Psoriasis Area Severity Index (MPASI) score. MPASI score was assessed monthly. Scores at the beginning and at the end of 3 months of treatment were compared. Quality of life was assessed using a questionnaire.
Results:MPASI score in group I was 57.15 ± 17.17 at baseline and 14.50 ± 13.55 at the end of 3rd month. The difference in scores before and after treatment was statistically significant. MPASI score in group II was 57.76 ± 18.60 at baseline and 21.30 ± 8.168 at the end of 3rd month. Intragroup analysis showed statistically significant difference before and after treatment. There was significant improvement in the quality of life after treatment.
Conclusion:Oral methotrexate reduces the lesions faster than acitretin. Both oral methotrexate and acitretin are highly effective in treating palmoplantar psoriasis and in improving patient’s quality of life.
Burns T, Breathnach S, Cox N, Griffiths C. Psoriasis. In: Burns T, Breathnach S, Cox N, Griffiths C, eds. Rook’s Textbook of Dermatology. 7th ed. US: Blackwell Publishing; 2004.
Brunasso AM, Puntoni M, Aberer W, Delfino C, Fancelli L, Massone C. Clinical and epidemiological comparison of patients affected by palmoplantar plaque psoriasis and palmoplantar pustulosis: a case-series study. Br J Dermatol. 2013;168:1243-51.
Petty AA, Balkrishnan R, Rapp SR, Fleischer AB, Feldman SR. Patients with palmoplantar psoriasis have more physical disability and discomfort than patients with other forms of psoriasis: implications for clinical practice. J Am Acad Dermatol. 2003;49:271-5.
Farley E, Masrour S, McKey J, Menter A. Palmoplantar psoriasis: a phenotypical and clinical review with introduction of a new quality-of-life assessment tool. J Am Acad Dermatol. 2009;60:1024-31.
Chung J, Callis Duffin K, Takeshita J, Shin DB, Krueger GG, Robertson AD, et al. Palmoplantar psoriasis is associated with greater impairment of health-related quality of life compared with moderate to severe plaque psoriasis. J Am Acad Dermatol. 2014 Oct;71(4):623-32.
Kircik L. Treatment of hand and foot psoriasis with emphasis on efalizumab. Skin Therapy Lett. 2007:12(9):4-7.
Camp RDR. PUVA therapy. In: Camp RDR, eds. Textbook of Dermatology. 1st ed. Oxford: Blackwell Publishing; 1992.
Weinberg JM. Successful treatment of recalcitrant Palmoplantar psoriasis with etanercept. Cutis. 2003 Nov;72(5):396-8.
Mehta BH, Amladi S. Evaluation of topical 0.1% tazarotene cream in the treatment of palmoplantar psoriasis: an observer blinded randomized controlled study. Indian J Dermatol. 2011 Jan-Feb;56(1):40-3.
Nikam BP, Amladi S, Wadhwa SL. Acitretin. Indian J Derm Venereol Leprol. 2006;72:167-72.
Pilkington T, Brogden RN. Acitretin: a review of its pharmacology and therapeutic use. Drugs. 1992;43:597-627.
Kalb RE, Strober B, Weinstein G, Lebwohl M. Methotrexate and psoriasis. J Am Acad Dermatol. 2009;60:5:824-37.
Wolverton SE. Methotrexate. In: Jeffrey PC, Carol L, eds. Comprehensive Dermatologic Drug Therapy. 1st ed. Philadelphia: Saunders; 2001: 163-177.
Tan J, Maari C, Nigen S, Bolduc C, Bissonnette R. Open-label exploratory study of acitretin for the treatment of severe chronic hand dermatitis. J Dermatolog Treat. 2014 Aug;26:1-3.
Charles B, Staff W. Palmoplantar psoriasis responds to retinoid. International Congress on Dermatology, 2009. Available at: http://www.medpagetoday.com/MeetingCoverage/ICD/14392.
Ravi BC, Kaur I, Kumar B. Topical methotrexate therapy in palmoplantar psoriasis. Indian J Dermatol Venereol Leprol. 1999;65:270-2.
Capella GL1, Fracchiolla C, Frigerio E, Altomare G. A controlled study of comparative efficacy of oral retinoids and topical betamethasone/salicylic acid for chronic hyperkeratotic palmoplantar dermatitis. J Dermatolog Treat. 2004;15(2):88-93.
Adisen E, Tekin O, Gulekon A, Gurer M. A retrospective analysis of treatment responses of palmoplantar psoriasis in 114 patients. J Eur Acad Dermatol Venereol. 2009;23(7):814-9.