Randomized double blinded placebo controlled comparative study of topical steroid plus bath PUVA versus bath PUVA and placebo cream
Keywords:
Bath PUVA, topical steroid, randomized double blinded, placebo controlledAbstract
Background The trend in psoriasis therapy in recent years has been to combine different agents in the hope that the combination will deliver better results. Topical corticosteroids are frequently used along with PUVA (Psoralen+ ultraviolet A) therapy in the treatment of psoriasis. But there is no consensus whether they enhance the therapeutic response of phototherapy. Our aim was to assess the effect of topical corticosteroids in combination with bath PUVA therapy on psoriasis with respect to time of clearance & duration of remission. Methods It was a double blind randomized placebo controlled study. Twenty patients were divided into two groups by block randomization. One group was treated with bath PUVA and betamethasone propionate cream in (30/70) dilution cream while the other group was treated with PUVA and placebo cream. Bath PUVA was given for 15 treatments or until 90% clearance of disease whichever is earlier.The assessment was done by PASITUL scoring at the baseline, 3rd, 6th, 9th, 12th and 15th sittings. Results Complete remission was achieved in all patients of steroid group and 8 patients of placebo group. The mean baseline PASITUL score decreased from 19.7 to 0.4 in steroid group and from 23.9 to 1.5 in placebo group. The mean cumulative UVA dose used in steroid and placebo groups were 32.85 Joules/cm2 and 40.60 Joules/cm2 respectively. The median number of UVA exposures used for >90% clearance in steroid group was 11 and for placebo group was 14 (p=.035). Out of 10 patients of steroid group 7 patients relapsed within six months while only 1 out of 8 patients who cleared completely in placebo group relapsed before 6 months (P=.023). Conclusion While there was tendency of early clearance in steroid group, there was no statistically significant difference in overall clearance and mean cumulative dose of UVA used. There were early relapses in steroid group which was statistically significant.ÂReferences
Dover JS, Mc Evoy MT, Rosen CF, Arndt KA, Stern RS. Are Topical corticosteroids useful in phototherapy of Psoriasis? J Am Acad Dermatol 1989;20:748-54
Horwitz SN, Johnson RA, Sefton J, Frost P. Addition of a topically applied corticosteroid to a modified Goeckerman regimen for treatment of psoriasis: effect on duration of remission: J Am Acad Dermatol 1985;13:784-91
Schmoll M, Henseler T, Christophers E. Evaluation of PUVA, topical corticosteroids and the combination of both in the treatment of Psoriasis. Br J Dermatol. 1978;99:693-702
Griffiths CEM, Barker JNWN. Psoriasis. In: Burns T, Breathnach SM, Cox NH, Grifï¬ths CEM, editors. Rook’s Textbook of Dermatology. 8th ed. London: Blackwell Publishing Ltd.; 2010. p. 20.1.
Lebwohl M, Ali S. Treatment of psoriasis. Part 1. Topical therapy and phototherapy. J Am Acad Dermatol 2001;45:487-98.
Grover C. Psoriasis. In: Sacchidanand S ed. IADVL Textbook of Dermatology.4th ed. Mumbai: Bhalani Publishing House;2015.p 1045-56
Hanke CW, Steck WD, Roenigk HH Jr. Combination therapy for psoriasis. Psoralens plus long-wave ultraviolet radiation with betamethasone valerate. Arch Dermatol. 1979;115:1074-7.
Emer J, Lebwohl. Combination, Rotational and sequential Therapies. In Koo JYM, Levin EC, Leon A, Wu JJ, Goettlieb eds. Moderate to severe psoriasis.4th ed. India: CRC Press; 2017.p 121-38
Dutta RK, Guba PK, Rathore BS. A Study of Puvasol and Puvasol with ariamcinolone Acetonide in psoriasis vulgaris. Indian J Dermatol Venereol Leprol.1985;51:263-6
Morison WL, Parrish JA, Fitzpatrick TB. Controlled study of PUVA and adjunctive topical therapy in the management of psoriasis. Br J Dermatol 1978;98:125-32.
LeVine MJ, Parrish JA. The effect of topical flucinonide ointment on phototherapy of Psoriasis.J Invest Dermatol 1982:78:157-159.
Petrozii JW. Topical steroids & UV radiation in psoriasis. Arch Dermatol 1983;119: 207-10.
Larkö O, Swanbeck G, Svatholm H. The effect on psoriasis of clobetasol propionate used in combination with UVB. Acta Derm Venereol 1984;64:151-54.
