Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Dermatol Ther. 2022 Nov;35(11):e15796. doi: 10.1111/dth.15796. Epub 2022 Sep 13.
Psoriasis is a papulosquamous disorder that causes significant social and psychological trauma to the patient. It is characterized by the presence of erythematous, indurated plaques covered with silvery-white scales. Despite the availability of several systemic agents that have been approved for the treatment of psoriasis, usually there are some residual lesions and there is a need to treat them for cosmetic reasons or symptomatic control. 1. Treatment of resistant localized psoriatic plaques or residuals after systemic treatment. 2. Recently, some intralesional agents have been used successfully for the treatment of psoriatic plaques as 5-FU, methotrexate, and botulinum toxin type-A, and nearly for four decades, no study focused on the effect of intralesional corticosteroids in the treatment of these psoriatic plaques. We decided to highlight their role and compare intralesional Triamcinolone to intralesional 5-FU regarding efficacy and safety in the treatment of plaque psoriasis. This study included 24 patients with localized plaque psoriasis. Each patient was treated by split-body therapy where one psoriatic plaque was treated with intralesional 5FU and another plaque with intralesional TAC. A total of three injections were given at 2-week intervals and follow up was regularly every 2 weeks up to 12 weeks. There was a statistically significant difference between both groups (p = 0.008) as the response rate on 5-FU side was 12.5% with no response, 29.2% with a moderate response, 41.7% with an excellent response, and 16.7% with a complete clearance, while on the TAC side it was16.7% with a moderate response, 20.8% with an excellent response and 62.5% with a complete clearance. Hyperpigmentation was the most irritating side effect of 5-FU that occurred. Pain, during and after injection, was greater in 5-FU group. Hypopigmentation and atrophy only occurred in TAC group in some patients but it seems to be reversible and not disfiguring. 1-Intralesional TAC injection may have more efficacy and less side effects than 5-FU injection in the treatment of localized plaque psoriasis. Hyperpigmentation and pain were the most irritating side effects of 5-FU 2-Intralesional TAC can be effective in the treatment of localized psoriatic plaques with minimal side effects, especially in patients not suitable for systemic agents.
银屑病是一种丘疹鳞屑性疾病，会给患者带来严重的社会和心理创伤。其特征为红斑、硬结斑块，表面覆盖银白色鳞屑。尽管有多种已被批准用于治疗银屑病的系统药物，但通常仍存在一些残留皮损，需要出于美容原因或控制症状而进行治疗。1. 治疗全身治疗后顽固的局限性银屑病斑块或残留皮损。2. 最近，一些皮损内药物已成功用于治疗银屑病斑块，如 5-FU、甲氨蝶呤和肉毒毒素 A，近四十年来，尚无研究关注皮损内皮质类固醇在这些银屑病斑块治疗中的作用。我们决定强调它们的作用，并比较皮损内曲安奈德和皮损内 5-FU 在治疗斑块状银屑病方面的疗效和安全性。这项研究纳入了 24 例局限性斑块状银屑病患者。每位患者均接受了分体疗法治疗，其中一个银屑病斑块接受皮损内 5-FU 治疗，另一个斑块接受皮损内 TAC 治疗。每 2 周注射 1 次，共 3 次，定期每 2 周随访 12 周。两组之间存在统计学差异（p=0.008），5-FU 组的反应率为 12.5%无反应，29.2%中度反应，41.7%极好反应，16.7%完全清除，而 TAC 组为 16.7%中度反应，20.8%极好反应，62.5%完全清除。5-FU 最常见的不良反应是皮肤色素沉着过度。5-FU 组在注射期间和之后的疼痛更严重。一些患者在 TAC 组中出现了皮肤色素减退和萎缩，但似乎是可逆的，不会造成畸形。1. 皮损内 TAC 注射治疗局限性斑块状银屑病的疗效优于皮损内 5-FU 注射，不良反应更少。2. 皮肤色素沉着过度和疼痛是 5-FU 最常见的不良反应。2. 皮损内 TAC 可有效治疗局限性银屑病斑块，不良反应最小，特别适用于不适合全身药物治疗的患者。
