Intralesional methotrexate vs intralesional 5-fluorouracil in the treatment of localized plaque psoriasis: a comparative clinical and dermoscopic study

Abstract

Background Multiple treatment options are introduced in the treatment of localized plaque psoriasis. However, long-term remission and total clearance can only be achieved in few patients. Aim The aim was to compare the efficacy and safety of intralesional methotrexate (MTX) and 5-fluorouracil (5-FU) in the treatment of localized plaque psoriasis both clinically and dermoscopically. Patients and methods Twenty patients with localized plaque psoriasis were enrolled in this study. Each patient was treated by split-body therapy where one psoriatic plaque was treated with intralesional MTX (25 mg/ml) and another plaque with intralesional 5-FU (50 mg/ml). A total of four injections were given at weekly intervals. The target lesions were clinically and dermoscopically evaluated at baseline, 1 week, 1 month, and 2 months after treatment. Results At the end of the study, the response rate was 85% on the MTX side and 95% on the 5-FU side. There was no significant difference between both sides regarding clinical response or side effects. Overall, there was a significant correlation between clinical response and the percentage of dermoscopic red dots. The recurrence rate was 15% on both sides. Notably, all recurring lesions on both sides were characterized by lack of clinicodermoscopic correlation. Conclusion Intralesional MTX and 5-FU are found to be an effective therapeutic modality in the treatment of localized plaque psoriasis with no significant side effects. Dermoscopy might be a useful tool for evaluating the response of psoriatic lesions to treatment and for early detection of recurrence of psoriasis.