Randomized clinical trial of compression therapy of the lower legs in patients with psoriasis

Abstract

Psoriatic plaques at the distal lower extremities are notoriously treatment resistant. Medical compression therapy could potentially be auseful supplementary therapeutic measure at this site. However, there is concern that the Koebner phenomenon may cause aworsening of the skin condition. Therefore, the purpose of this study was to investigate the effects of compression therapy on psoriatic plaques in the presence of coexisting edema of the lower legs. Compression therapy was performed in addition to standard of care on one lower leg for 4weeks (half-side test) in patients with psoriatic plaques and edema on both lower legs. The primary endpoint of the study was clinical response of the psoriatic plaques on the lower legs measured with the lesion severity score (LSS) and the locally affected body surface area in aside-by-side comparison at week4 compared with baseline. Secondary endpoints were related to patient-reported outcomes. Data from 30patients were included in the analysis. In the descriptive analysis, the mean LSS results and the subjective pain reported by the patients showed aslightly greater improvement on the compressed lower leg compared with the non-compressed lower leg. None of the patients showed evidence of the Koebner phenomenon induced by compression therapy. This is the first clinical study that systematically investigated the impact of compression therapy on psoriatic plaques. During the study period of 4weeks, there was no significant improvement in psoriatic plaques; however, there was also no evidence of worsening of the skin condition. Thus, anti-edematous compression therapy can be performed in psoriasis patients without causing complications if basic contraindications are considered.