RESUMO
Background: Palmoplantar psoriasis is a chronic debilitating condition which significantly impairs quality of life. Objectives: To assess the efficacy and safety of the combination of apremilast and methotrexate compared with methotrexate monotherapy in the treatment of palmoplantar psoriasis. Also, to study the impact on treatment on the Dermatology Life Quality Index and Palmoplantar Quality of Life Index. Methods: A total of 64 patients were randomised to two groups in a 1:1 ratio - Group A received both methotrexate and apremilast in combination, while Group B received only methotrexate, for 16 weeks. The primary endpoints were the mean score of Modified Palmoplantar Psoriasis Area and Severity Index at week 16, the proportion of patients achieving modified palmoplantar psoriasis area severity index-75 and/or Palmoplantar Psoriasis Physician Global Assessment score 0/1 at week 16. Results: A significantly higher proportion of patients in Group A achieved Modified Palmoplantar Psoriasis Area and Severity Index-75 at week 16 (43% in Group A vs 30% in Group B). The Modified Palmoplantar Psoriasis Area and Severity Index score was significantly lower in the combination group at week 16 (4.03 ± 2.05 in Group A and 5.89 ± 2.31 in Group B, P-value = 0.002). About 80% of patients in the combination group with baseline Palmoplantar Psoriasis Physician Global Assessment ?3 achieved Palmoplantar Psoriasis Physician Global Assessment 0/1 compared to 60% in Group B. The combination group showed a significantly higher reduction in Dermatology Life Quality Index and Palmoplantar Quality of Life Index scores compared to the methotrexate alone group (P-value = 0.025). No notable adverse events were observed. Limitation: The limitations of the study were single blinding, small sample size and a lack of longer follow up to assess the rate of relapse. We did not account for attrition during sample size calculation. Also, due to the paucity of data regarding the use of apremilast in palmoplantar psoriasis, definitive comparisons could not be made with previous studies. Conclusion: The combination of apremilast and methotrexate has superior efficacy and a similar safety profile as compared to methotrexate monotherapy for the treatment of moderate to severe palmoplantar psoriasis
RESUMO
Introducción: la psoriasis es una enfermedad dermatológica crónica de causa desconocida, donde se invocan diferentes factores que actúan sobre su patogenia, dentro de ellos el papel de la inmunidad, el factor psicógeno, su carácter inflamatorio, la teoría de la hiperproliferación celular y de los mediadores. Objetivo: determinar la utilidad de los campos magnéticos en el tratamiento de la psoriasis. Métodos: se realizó un estudio cuasi experimental longitudinal prospectivo. A los pacientes se les realizó tratamiento con campo magnético 50 Hz, 10 min diarios de lunes a viernes, 30 sesiones. Se realizó la evaluación clínica al inicio y en las semanas 2, 4 y 8 a través del índice de gravedad de la psoriasis. Se clasificaron los resultados en blanqueamiento, respondedor, no respondedor y empeoramiento. Resultados: el 22 por ciento (22 pacientes) tuvo blanqueamiento de las lesiones, 75 fueron respondedores, ocho no respondedores y en un paciente hubo empeoramiento. La forma clínica de mejor evolución fue la del cuero cabelludo con un 88 por ciento de blaqueamiento. Conclusiones: se consideró que la magnetoterapia fue una opción útil en el tratamiento del paciente con psoriasis
Introduction: psoriasis is a chronic dermatologic disease of unknown cause where there are different factors acting on its pathogenesis including the role of immunity, the psychogenic factor, its inflammatory character, the theory of the cellular hyperproliferation and of mediators. Objective: to determine the usefulness of magnetic fields in treatment of psoriasis. Methods: a prospective, longitudinal and quasi experimental study was conducted. Patients received treatment with 50 Hz magnetic field, 10 minutes daily from Monday to Friday for 30 sessions. A clinical assessment was carried out at onset and at weeks 2, 4 and 8 by severity index of the psoriasis. The results in whitening, response, not-response and worsening were classified. Results: the 22 percent (22 patients) had a whitening of lesions, 75 had answer, eight not-answers and in a patient there was worsening. The clinical way of a better course was that of scalp with a 88 percent of whitening. Conclusions: magnetotherapy was an useful option in treatment of psoriasis patient