Pattern of drug use in the management of psoriasis in a tertiary care hospital: a prospective study.

ABSTRACT

Background: Psoriasis is a chronic skin disease, characterized by chronic and recurrent scaly plaques with itching. The treatment modalities for psoriasis include topical, systemic, and phototherapy (PT). The pattern of therapy may vary depending upon the type, severity, and duration of the disease. As there are few reports in the Indian literature regarding the pattern of drug use in psoriasis and evaluating the efficacy and patient compliance to treatment, the present study was conducted. Methods: This was a prospective, observational study conducted on 121 newly diagnosed and untreated patients with psoriasis, who attended Dermatology outpatient department of a tertiary care hospital. The severity of the disease was assessed by baseline psoriasis area severity index (PASI) score. Most of the patients were treated with topical therapy consisting of glucocorticoids (GC) monotherapy or combination with, salicylic acid, calcitriol and coal tar. Systemic therapy and PT were considered only for severe cases of psoriasis with baseline PASI score >4. The patients were monitored every 2 weeks for 3 months. Results: The topical medications induced effective resolution of lesions in most of the patients, along with adequate symptomatic relief. The response to GC monotherapy was found significant (90.47%; p<0.001) and there was 76.13% decrease in PASI score in chronic plaque psoriasis, indicating significant improvement (p<0.001) after 12 weeks of therapy. More than 94% of study patients showed good compliance to medications and only 0.27% showed poor compliance, whereas the other patients showed a moderate compliance of 80-95%. Conclusions: Most of the patients with psoriasis can be effectively treated with topical medications, and additional systemic and/or PT may be required only for severe cases of chronic plaque psoriasis with baseline score >4. Regular follow-up is required not only to monitor the treatment response, but also to ensure good patient compliance by proper counseling.