Original Research Article
Year: 2019 | Month: December | Volume: 6 | Issue: 12 | Pages: 221-228
Comparison of Effects of Injection Methotrexate with Injection Methotrexate and Injection Triamcinolone Acetonide in the Management of Palmoplantar Psoriasis- An Open, Randomized Comparative Study
Suchibrata Das1, Sudip Das2
1Assistant Professor, Department of Dermatology, Venereology and Leprosy, NRS Medical College, 138 AJC Bose Road, Kolkata, West Bengal, India, Pin- 700014
2Professor, Department of Dermatology, Venereology and Leprosy, Calcutta National Medical College, 32, Gorachand Road, Beniapukur, Kolkata, West Bengal, India, Pin- 700014
Corresponding Author: Suchibrata Das
ABSTRACT
Introduction- Chronic PalmoPlantar Psoriasis (PPPs) is an idiopathic condition located on palms and soles. As complete clearance is difficult, Pain reduction and functional improvement may be the more important therapeutic goal.
Aims and objectives - To compare the effects of injection Methotrexate (MTX) and Inj TATA Acetonide (TA) in Palmoplantar Psoriasis with injection Methotrexate and relapse after stopping the therapy.
Materials and methods- Clinically PPPs Patients (16 -65 years) with involvement of more than 25% of palm and/or sole was included in the study and divided in two groups. Group A consisted of patients getting MTX 15mg single weekly dose for 6 weeks, Group B patients got MTX 15mg single weekly dose for 6 weeks and Injection TA40mg deep IM injection, 2 injections each in 3 weeks interval. Disease improvement documented and assessed by Modified PASI scoring system and Target area Scoring.
Results – Both the modalities of treatments were effective. In MTX Group, reduction of Mean Modified PASI was 45.58% at 4 weeks and in Combined group it was 66.3%. In MTX only group PASI75 (Mean Modified PASI) was achieved in 13.6% patients after 6 weeks whereas 31.8% patients in combined group achieved PASI75(Mean Modified PASI). After 6 weeks of therapy, 64.68% reduction occurred in MTX only group but in Combined group the reduction was 83.8%. The MTX- TA group showed significant early improvement in Target Area Score. There were no difference of relapse pattern and rate in MTX and TA injection group. Patients satisfaction after treatment was recorded in a graded scale. Only 9.1% patients opined excellent about the response of therapy in MTX group whereas 40.9% excellent in combined group. The differences of Dermatology Quality of Life Index at beginning and end of the study were significant.
Conclusion –Combination of MTX with inj TA is more effective therapy for early reduction of severity of PPPs. It changes the Quality of life dramatically. Patients satisfaction with this combination therapy is higher than Methotrexate only therapy. Chances of relapse are same in both groups, and rebound exacerbation of disease was not an apprehension in combination therapy.
Key words: Palmoplantar Psoriasis, Methotrexate, Inj Triamcinolone, Modified PASI, Target Area Score, DLQI
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