Efficacy of intralesional injection of platlet rich plasma in combination with methoterexate in chronic plaque psoriasis

Abstract

ABSTRACT   INTRODUCTION Psoriasis affects high number of the world's population so there is an urgent need for new treatment strategy, as up to 50% of patients are not satisfied with current therapies. Recently it is suggested that combination of platelet rich plasma (PRP) and methotrexate (MTX) can be used in the management of patients with plaque psoriasis.    OBJECTIVE To determine the efficacy of intradermal injection of platelet rich plasma in combination with methotrexate in patients of chronic plaque psoriasis   METHODS It was a descriptive case series conducted in department of dermatology, FJMU/SGRH Lahore from April 4, 2018 till Oct 4, 2018. A total number of 73 patients enrolled from outpatient department, after approval from ethical review board and written informed consent, patients fulfilling the inclusion and exclusion criteria. The demographic information like age, gender, address was collected and recorded as per proforma. All cases were treated under supervision of consultant dermatology having more than 5 years of experience to avoid bias. The study was conducted for 16 weeks, in which patients were treated for a period of 15 weeks and results were calculated by the end of 16th week. All cases were treated with PRP and MTX both. Autologous PRP was prepared from patient’s peripheral blood through 2-stage centrifugation process as per established protocol. Each patient was given intra-lesional PRP in psoriatic plaques on 1st week, 0.1 ml of PRP was given at each point with 2cm spacing followed by 15mg of intralesional MTX weekly for 4 weeks i-e 2nd, 3rd ,4th and 5th week` after 1 week of PRP injection, 15 mg of MTX were divided among the plaques so that 1.25mg was given at each point with a space of 2cm between two points. Second administration of intralesional PRP was done in the psoriatic plaques on 6th week followed by similar administration of intra-lesional MTX on 7th,8th,9th and 10th week. Third intralesional PRP was given on 11th week and then intra-lesional MTX was given again on 12th, 13th,14th and 15th week. Both PRP and MTX were administered through intra-lesional route to circumvent toxicity associated with systemic administration. All cases were observed for the effect of treatment by the end of 16th week and PASI was calculated. Efficacy was labelled as per operational definition.   RESULTS The mean age of cases was 39.60 ±12.15 years with minimum and maximum ages as 18 and 60 years. There were 24 (32.88%) male and 49 (67.12%) female cases, with higher female cases. According to operational definition 60 (82.19%) had efficacy while 13 (17.81%) cases did not meet the criteria of efficacy.   CONCLUSION The efficacy of intradermal injection of platelet rich plasma in combination with methotrexate in patients of chronic plaque psoriasis is highly effective. This combination can be utilized for substantial improvement in term of improvement of PASI score.     Keywords: Psoriasis; anti-inflammatory; PASI; PRP; combination therapy