Yuva Priya, B (2022) A Comparative study on Clinical Efficacy of Platelet Rich Plasma in Combination with Methotrexate Versus Methotrexate Monotherapy Versus Conventional Topical Therapy in Chronic Plaque Psoriasis. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Psoriasis is a chronic inflammatory, non-communicable disease that predominantly involves skin, nails, joints and associated with systemic manifestations in many organs. The World Health Organization noted that the reported prevalence of psoriasis worldwide ranges between 0.09% to 11.43%, making psoriasis a serious global health problem with at least 100 million individuals affected all over the world. Psoriasis, an inflammatory dermatosis is marked by elevated levels of active phosphorylated NFκB which is the key regulator element in inflammatory pathway, apoptosis, in cellular proliferation and differentiation. Psoriasis is associated with significant negative impact on patient's physical and mental health. Psoriatic patients are at higher risk of developing cardiovascular disorders and associated with multitude of psychological impairment and also have an increased rate of suicidal ideation. The management of psoriasis has witnessed an immediate need for new treatment modality as up to 50% of patients are not content with present therapy. AIMS AND OBJECTIVES: 1. To compare the clinical efficacy of intralesional PRP with methotrexate, intralesional methotrexate monotherapy and conventional topical therapy in the treatment of chronic plaque psoriasis. 2. To assess the adverse effects associated with intralesional PRP and intralesional methotrexate. 3. To determine the recurrence rate after treatment. MATERIALS AND METHODS: Study Design: Randomized controlled trial Study Centre: Department of Dermatology, Madras Medical College & Rajiv Gandhi Government General Hospital, Chennai- 3. Study period: One year six months (November 2019 – April 2021). Study Population: Patients with localized chronic plaque psoriasis attending OutPatient clinic of Department of Dermatology, Madras Medical College & Rajiv Gandhi Government General Hospital during the study period. Inclusion Criteria: 1. Patients of more than 18 years of age attending, the Dermatology OPD during the study period with localized stable plaque psoriasis for 6 months, involving < 10% of Body Surface Area and maximum PASI of 10 at the time of screening will be included. 2. Patient who has not undergone any prior systemic or topical treatment. 3. Those who are willing to give consent to participate in the study. Exclusion Criteria: 1. Prior known allergic response to methotrexate. 2. Patients who received any other treatments for their psoriasis before enrollment, 3. Patients with history of renal, liver impairment, allergic skin disorders and blood dyscrasia, 4. Patients with acute febrile illness or signs of any inflammation or infection, 5. Patients with Hepatitis B & Hepatitis C infection, 6. Patients with immunosuppression/ HIV Infection, 7. Patients with pustular / erythrodermic psoriasis, 8. Patients of <18 years of age, 9. Pregnant women, 10. Patients who are not willing for study. Sample Size: Sixty six patients (66) attending the OutPatient clinic of Department of Dermatology, Madras Medical College & Rajiv Gandhi Government General Hospital and who satisfied the above criteria were included during the study period. CONCLUSION: The mean duration of the disease was 2.3 years (27.6 months). When the patients present in their early stage of the disease, the treatment response will be better. • In our study, there was significant improvement noted both with PRP in combination with methotrexate and topical corticosteroids therapy with emollients. • But the magnitude of improvement was higher in patients treated with PRP in combination with intralesional methotrexate. • There is statistically significant improvement in Group A when compared to Group B at the end of third month of treatment. • So intralesional methotrexate monotherapy as a single modality of treatment in patients with psoriasis is not as effective when compared to PRP with intralesional monotherapy. • Similarly topical corticosteroids therapy group showed significant improvement at third month than intralesional methotrexate monotherapy. • The occurrence of adverse effects profile were also statistically similar between PRP with intralesional methotrexate group and intralesional methotrexate monotherapy group. • The patients have to be counselled regarding the modality of treatment to be used, when to expect response, about the natural course of disease, adherence to treatment before starting treatment. • The recurrence rates are minimal in all the three groups of treatment. LIMITATIONS: In our study, there were certain limitations. The sample size was small in our study. Although the drugs were given intralesionally, it can act systemically and may have effect on the disease process. So the improvement cannot be attributed to a single drug. The follow up was done only for a limited time.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 201930027 |
| Uncontrolled Keywords: | Clinical Efficacy, Platelet Rich Plasma, Methotrexate, Methotrexate Monotherapy, Conventional Topical Therapy, Chronic Plaque Psoriasis. |
| Subjects: | MEDICAL > Dermatology Venereology and Leprosy > MEDICAL > Dermatology Venereology and Leprosy |
| Depositing User: | Subramani R |
| Date Deposited: | 18 Apr 2021 03:05 |
| Last Modified: | 16 Mar 2024 02:40 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14873 |
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