Comparative study of topical 0.1% tazarotene cream versus calcipotriol 0.005% ointment in the treatment of palmoplantar psoriasis

Abstract

Palmoplantar psoriasis is classified into two types based on morphology- hyperkeratotic palmoplantar psoriasis and pustular palmoplantar psoriasis. Hyperkeratotic palmoplantar psoriasis presents with well defined erythematous scaly plaques with overlying hyperkeratosis without the presence of sterile pustules, predominantly at the palms and/or soles. There is greater physical and functional disability in patients of palmoplantar psoriasis. Patients with palmoplantar disease are more likely to suffer from a significant impact on skin-related QoL, have problems with activities of daily living, and rely on topical prescription medications than patients with moderate-to-severe plaque psoriasis. These differences are important while creating therapeutic strategies and in understanding patients’ expectations of the treatment. Objective: To compare the clinical efficacy and study the adverse effects of topical 0.1% tazarotene cream and 0.005% calcipotriol ointment in the treatment of palmoplantar psoriasis.A total of 82 palmoplantar psoriasis cases who attended the OPD of a tertiary care hospital in Northern India for a period of two years formed the study group. The study group was randomized into Group A and Group B. Group A participants were instructed to apply a liquid paraffin-based emollient in night, followed by 0.1 % tazarotene cream under occlusion for 12 weeks. Group B patients were instructed to apply calcipotriol ointment 0.005% twice daily on lesions and a liquid-paraffin based emollient in night daily for 12 weeks. The response to treatment was evaluated by improvement in PPPASI at 2-week interval up to 12 weeks.At 12 weeks of follow-up 42.9% patients showed an excellent response, 31.4% showed a clear response in group A. In group B 25% patients had an excellent response and 10% patients showed complete clearance. Adverse effects were seen more in group A.Topical treatment modalities for palmoplantar psoriasis are effective and have a low risk for adverse effects. Both topical calcipotriol 0.005% and tazarotene 0.1% cream are effective in the treatment of palmoplantar psoriasis. While topical tazarotene 0.1% cream showed an excellent clinical response among patients, it was associated commonly with adverse effects such as local irritation and itching in initial weeks of the treatment. Usage of topical 0.005% calcipotriol ointment showed a good clinical response among the patients, with mild side effects of local irritation and itching which resolved on subsequent treatment.