Comparative study of the Efficacy of Various Topical Treatment Modalities in Palmoplantar Psoriasis.

Renuga, V (2007) Comparative study of the Efficacy of Various Topical Treatment Modalities in Palmoplantar Psoriasis. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION : Psoriasis is a common, genetically determined, inflammatory and proliferative disease of the skin. The most characteristic lesions consist of red, scaly, sharply demarcated, indurated plaques present particularly on the elbows, knees, lowerback, extensor surfaces and scalp. The first recognisable description of psoriasis is attributed to Celsus (25BC-45AD) in his de re medica nearly 2000 years ago. The disease was described under the heading of impetigo from the Latin word impeto which means "to attack or rush on" Galen was the first to use the word psoriasis from the Greek work 'psora' which means 'to itch'. Psoriasis and Leprosy were grouped together for centuries. Willan was the first to accurately describe psoriasis and its various manifestations in 1809, but he did not separate it with certainty from Leprosy. In 1841, Hebra definitively distinguished the clinical picture of psoriasis from that of Hansen's disease. Eventhough a number of treatment modalities are available, psoriasis continues to be a therapeutic challenge in spite of our growing knowledge of its pathogenesis. AIM OF THE STUDY : Palmoplantar psoriasis is a chronic disease with remissions and exacerbations. Most of the topical therapies currently available for psoriasis are either suited for short term therapy or long term maintenance therapy. Furthermore topical corticosteroids commonly used for palmplantar psoriasis, show diminished response on continuous use due to tachypylaxis and more incidence of recurrence. OBJECTIVE : To compare the efficacy of various topical therapies like Short contact compound dithranol ointment (dithranol 1.15%, salicylic acid 1.15%, coal tar solution 5.3% in white soft paraffin) Topical 0.1% Betamethasone valerate ointment Topical tazarotene 0.05% gel Topical PUVA using -1% methoxypsoralen solution Liquid paraffin. CONCLUSION : Topical therapies are the first line therapeutic strategy in the treatment of localized palmoplantar psoriasis and can be made effective when the appropriate drugs were used judiciously. Among the five modalities compared in this study, tazarotene (0.05%) gel may be considered as an initial treatment of choice. Topical PUVA is as effective as tazarotene except for the limiting factors for PUVA therapy such as availability of PUVA unit, patient compliance and long term side effects. Topical dithranol is as effective as topical PUVA when used as 20minutes short contact therapy. Topical 0.1% Betamethasone valerate was moderately effective with frequent exacerbation. Liquid paraffin was the least effective with no adverse effects, no exacerbation and remissions. However it can be used as an adjunct with other topical therapies.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Topical Treatment Modalities ; Palmoplantar Psoriasis ; Comparative study.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 05 Jul 2017 01:47
Last Modified: 05 Jul 2017 08:25

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