Palmoplantar Psoriasis: A Comparative Therapeutic study

INTRODUCTION: Psoriasis is an immunologically mediated inflammatory dermatosis characterized by erythematous scaly plaques, extremely variable in clinical manifestations ranging from innocuous lesions to life threatening pustular & erythrodermic psoriasis. Palmoplantar psoriasis present as hyperkeratotic plaques with fissures leading to significant disability. Palmoplantar psoriasis can managed with either topical agents, phototherapy or systemic agents AIMS AND OBJECTIVES: 1. To study the therapeutic efficacy of a) oral methotrexate, b) hand & foot phototherapy using NBUVB, c) topical calcitriol with clobetasol propionate ointment. 2. To do clinical evaluation using PASI scoring and assess quality of improvement using DLQI. MATERIALS AND METHODS: Sixty patients with palmoplantar psoriasis were randomly selected. Clinical examination and necessary investigations were done and PASI scoring calculated to assess the area involved. Patients were grouped under three groups. Group A patients were put on calcipotriol with clobetasol propionate ointment. Group B patients had hand and foot NB-UVB. Group C patients were put on tablet methotrexate. OBSERVATION AND RESULTS: Thirty three patients were males with male to female ratio of 1.22:1. Mean age of patients was 36. Mean duration of illness was 11months. Most of the patients were manual labourers. 36 patients had lesions over palms and soles, 9 palms alone and 15 involving soles. Mean PASI reduction at 16weeks was maximum with methotrexate. Compliance was good with methotrexate and topical group. Relapse cases were seen with methotrexate. CONCLUSION: There is no significant change in clinico-epidemiology and presentation of palmoplantar psoriasis. Methotrexate is the most efficacious modality in treatment of palmoplantar psoriasis