Abstract
Objective: To assess the efficacy of Methotrexate in patients with plaque type psoriasis. Methods: This descriptive study was conducted in the department of Dermatology, Civil Hospital Karachi from September 2009 to March 2010. Seventy three patients between 18 to 50 years of age suffering from plaque type psoriasis with PASI score of >10 were included in the study after taking the informed consent. Oral methotrexate in a dose of 7.5 mg/week was given for 8 weeks. The data collected included demographic profile (age and gender), duration of disease, site of involvement, size of plaque, severity of plaque measured by Psoriasis Area and Severity Index (PASI) score before starting the treatment and at the end of treatment. Efficacy was labeled with a PASI score of ≤5 at the end of 8 weeks. Results: Out of 73 patients there were 45 (61.6%) males and 28 (38.4%) females. The mean ±SD age was 40.0±12.6 years. The mean baseline PASI score showed clear and comparable improvement from a mean ± SD PASI score of 14.8±4.2 to 4.9±4.3.Twenty nine (40%) patients had an almost complete remission during the 8 weeks of treatment. Partial remission was achieved in 44 (60%) patients. The clearance time for psoriasis ranged from 5-7 weeks (mean 6±0.89 weeks). Conclusion: Treatment with methotrexate for chronic plaque psoriasis brings satisfactory disease control and improved quality of life.
Highlights
Patients presenting to Out Patients Department (OPD) of Dermatology, Dow University of Health Sciences & Civil Hospital, Karachi, with diagnosis of plaque type psoriasis fulfilling the inclusion criteria were included after taking informed consent
The data was collected on a predesigned proforma from each patient and included demographic profile, duration of disease, site of involvement, size of plaque, severity of plaque measured by Psoriasis Area and Severity Index (PASI) score before starting the treatment and efficacy
The present study demonstrated a good efficacy of oral methotrexate in the treatment of plaque psoriasis
Summary
Chronic, inflammatory and proliferative skin disorder in which both genetic and environmental factors have a critical role.[1,2] The characteristic lesions consist of red, scaly, sharply demarcated, indurated plaques, present over extensor surfaces and scalp.[3,4] Chronic plaque psoriasis has an estimated worldwide prevalence of 0.1-3%.5 Upto 50% of patients may enter in remission phase spontaneously for different periods of time.[6]. In developing country like Pakistan, methotrexate is an economical and effective antipsoriatic agent and is given for extensive plaque type psoriasis, erythrodermic, acute pustular and severe psoriatic arthropathy.11It acts by inhibiting DNA synthesis by competitive inhibition of dihydrofolatereductase and have an anti-mitotic action on psoriatic skin.[9] Methotrexate was originally used in psoriasis due to its effect on rapidly dividing keratinocytes, it has anti-inflammatory and immunomodulating properties. Based on the available clinical data it is suggested that the methotrexate may reduce the severity of psoriasis in at least 75% of patients.[12] Psoriasis is a common skin disorder and extensive disease generally does not respond to the topical treatment. Facilities for the phototherapy are not widely available in our country and other systemic treatment option are either expensive or have significant side effects. The rationale of the study was to find out the efficacy of methotrexate so that it could be used in subsequent patients as a cost effective treatment modality
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