背景银屑病是一种形态变化的丘疹鳞状疾病,分布,严重程度,当然。慢性斑块型银屑病,或者寻常型牛皮癣,是牛皮癣最常见的形式。目前用于局部使用的轻度至中度慢性斑块状银屑病的可用制剂是局部皮质类固醇,煤焦油,地物酚,他扎罗汀,卡泊三醇,tapinarof,和钙调磷酸酶抑制剂.然而,每种准备都有其缺点。卡泊三醇,维生素D的活性形式,可用于皮肤的局部形式。慢性斑块型银屑病是卡泊三醇用于轻度至中度形式的主要医学用途。当全身使用时,甲氨蝶呤在牛皮癣中具有显著结果。现在,局部制剂在局部牛皮癣中被提倡,这与系统形式的副作用无关。因此,本研究旨在比较基于银屑病面积严重度指数(PASI)的局部卡泊三醇和局部甲氨蝶呤在慢性斑块型银屑病患者中的有效性,并比较其在不良反应方面的安全性.方法纳入研究的患者总数为60。他们被分成两组,每人30名患者。一组是处方软膏卡泊三醇0.005%,每天两次局部应用(C组)。另一组规定每日两次局部应用1%甲氨蝶呤凝胶(M组)。患者在第4周和第8周进行随访,每一次,对所有患者进行了全面的临床检查。每次计算每个患者的PASI评分。通过生化参数评估安全性,通过不良反应的发生率评估耐受性.纳入研究的所有患者均在基线时进行调查,第四周,第八周将收集的数据转移到主图并进行分析。结果C组患者,第0周PASI平均得分为5.93±2.62,第4周,平均PASI评分下降到1.67±1.13,在八周时,平均PASI评分进一步下降至0.67±0.68.对于M组的患者,第0周PASI平均得分为5.91±2.22,而第4周,平均PASI评分下降到1.91±1.11,在八周时,平均PASI评分进一步下降至0.89±0.72。此外,两组间比较,各时间点的平均PASI评分无显著差异(p值分别为0.761,0.296,0.079).因此,两种药物似乎都能有效治疗轻度至中度慢性斑块状银屑病.两组中的大多数患者都显示出明显的病灶清除。然而,卡泊三醇组中有6例患者表现出轻度斑块状银屑病的病变完全清除,与甲氨蝶呤组的三名患者相比。在本研究中,基于安全性和耐受性的比较,卡泊三醇组30例患者中有4例(13.3%)受到皮肤刺激,而甲氨蝶呤组30例患者中有6例(20%)主诉有烧灼感.在患者中看到的不良反应是短暂的和轻微的。结论卡泊三醇和甲氨蝶呤可有效减轻慢性轻中度斑块型银屑病患者的皮损。两种药物均具有良好的耐受性,具有轻度和短暂的不良反应,并且不会改变血液学和生化参数。
Background Psoriasis is a papulosquamous disease with variable morphology, distribution, severity, and course. Chronic plaque psoriasis, or psoriasis vulgaris, is the most common form of psoriasis. Present available preparations for mild to moderate chronic plaque psoriasis for topical use are local corticosteroids, coal tar, dithranol, tazarotene, calcipotriol, tapinarof, and calcineurin inhibitors. However, every preparation has its disadvantages. Calcipotriol, an active form of vitamin D, is available in topical form for dermatological use. Chronic plaque psoriasis is the chief medical use of calcipotriol for mild to moderate form.
Methotrexate has dramatic results in psoriasis when used systemically. Now, topical formulation is being advocated in localized psoriasis, which is not associated with the side effects of the systemic form. Therefore, this
study aimed to compare the effectiveness of topical calcipotriol and topical
methotrexate on the basis of the psoriasis area severity index (PASI) in patients of chronic plaque psoriasis and compare their safety in terms of adverse effects. Methodology The total number of patients included in the
study was 60. They were divided into two groups, with 30 patients each. One group was prescribed ointment calcipotriol 0.005% twice daily local application (Group C). The other group was prescribed methotrexate gel 1% twice daily local application (Group M). The patients were followed up on the fourth and eighth weeks, and at each time, thorough clinical examinations were conducted for all patients. The PASI score was calculated in each patient every time. Safety was assessed by biochemical parameters, and tolerability was assessed by the incidence of adverse effects. All the patients included in the
study were investigated at baseline, fourth week, and eighth week. The data collected were transferred to a master chart and analyzed. Results For the patients in group C, the mean PASI score at 0 week was 5.93 ± 2.62, while at four weeks, the mean PASI score declined to 1.67 ± 1.13, and at eight weeks, the mean PASI score further declined to 0.67 ± 0.68. For the patients in group M, the mean PASI score at 0 week was 5.91 ± 2.22, while at four weeks, the mean PASI score declined to 1.91 ± 1.11, and at eight weeks, the mean PASI score further declined to 0.89 ± 0.72. Furthermore, there was no significant difference in the mean PASI score at various time points when compared between the two groups (p-value = 0.761, 0.296, 0.079, respectively). Thus, both drugs seem to be effective in treating mild- to moderate-grade chronic plaque psoriasis. Most of the patients in both groups showed marked clearance of the lesions. However, there were six patients in the calcipotriol group showing complete clearance of the lesions having mild-degree plaque psoriasis, as compared to three patients in the methotrexate group. In the present
study, based on the comparison of safety and tolerability, four out of 30 patients (13.3%) in the calcipotriol group suffered skin irritation, whereas six out of 30 patients (20%) in the methotrexate group complained of a burning sensation. The adverse effects seen in the patients were transient and mild. Conclusion Topical calcipotriol and methotrexate were effective in reducing lesions in patients with chronic mild to moderate plaque psoriasis. Both drugs were well tolerated with mild and transient adverse effects and did not alter hematological and biochemical parameters.