Ara Shamim, Mowla Mohammad Rafiqul, Alam Mansurul, Khan Ismail
Department of Dermatology and Venereology, Chittagong International Medical College, Chittagong, Bangladesh.
Department of Dermatology and Venereology, Chittagong Medical College, Chittagong, Bangladesh.
Dermatol Ther. 2020 Jul;33(4):e13486. doi: 10.1111/dth.13486. Epub 2020 Jun 10.
Palmoplantar psoriasis (PPP) is a chronic, inflammatory dermatosis of the palms and/or soles with significant morbidity. It is notoriously difficult to treat and unresponsive to traditional topical agents. We aim to compare the effect of oral methotrexate (MTX) monotherapy vs MTX plus narrowband ultraviolet light B (NB-UVB) in the treatment of recalcitrant PPP. This was a comparative clinical trial involving 90 patients of PPP. Eligible patients were randomly assigned to one of the two treatment groups. We aim patients in group A received 10 mg oral MTX weekly, and patients in group B received oral MTX 10 mg weekly and NB-UVB sessions twice weekly for 12 weeks. There was a statistically significant difference in reduction of modified PPP Area Severity Index (m-PPPASI) of patients in MTX plus NB-UVB at week 12. The mean m-PPPASI at week 12 was 3.66 ± 2.11 in MTX plus NB-UVB group and 6.51 ± 2.04 in MTX only group (P < .001). Marked improvement (m-PPPASI 75) was achieved in 20 (44.44%) patients in MTX plus NB-UVB group compared with 6 (13.3%) in MTX monotherapy group (P < .001). Combination of MTX and NB-UVB phototherapy helps to attain a better clinical response (reduction in m-PPPASI score) than MTX monotherapy in the treatment of recalcitrant PPP.
掌跖银屑病（PPP）是一种发生于手掌和/或足底的慢性炎症性皮肤病，发病率较高。其治疗难度极大，对传统外用药物无反应。我们旨在比较口服甲氨蝶呤（MTX）单药治疗与MTX联合窄谱中波紫外线（NB-UVB）治疗顽固性掌跖银屑病的效果。这是一项涉及90例掌跖银屑病患者的对照临床试验。符合条件的患者被随机分配到两个治疗组之一。我们让A组患者每周口服10 mg MTX，B组患者每周口服10 mg MTX并每周接受两次NB-UVB照射，共12周。在第12周时，MTX联合NB-UVB组患者的改良掌跖银屑病面积严重程度指数（m-PPPASI）降低有统计学显著差异。MTX联合NB-UVB组在第12周时的平均m-PPPASI为3.66±2.11，仅MTX组为6.51±2.04（P<0.001）。MTX联合NB-UVB组有20例（44.44%）患者实现显著改善（m-PPPASI降低75%），而MTX单药治疗组为6例（13.3%）（P<0.001）。在治疗顽固性掌跖银屑病方面，MTX与NB-UVB光疗联合使用比MTX单药治疗能获得更好的临床反应（m-PPPASI评分降低）。
