Management of guttate and generalized psoriasis vulgaris: prospective randomized study.

AIM To assess the efficacy of betamethasone dipropionate 0.05% cream plus ultraviolet B (UVB) radiation with and without additional penicillin therapy in the treatment of guttate psoriasis, and to compare the efficacies of oral psoralen plus ultraviolet A (PUVA) therapy and systemic retinoids therapy for treatment of generalized psoriasis. METHODS Sixty patients with guttate (n = 20) and generalized psoriasis vulgaris (n = 40) of various intensity and duration treated at the Department of Dermatology, Medical School in Skopje, from February 2000 to January 2002, were included in this prospective, open-label, randomized, parallel group study. The clinical features of the patients were quantified according to the mean psoriasis area and severity index (PASI) values. Student s t-test for paired samples and two independent samples were used in statistical analysis. RESULTS The final PASI values were not significantly different for the patients receiving different treatments of guttate psoriasis or generalized psoriasis. The initial PASI values for guttate psoriasis patients treated with betamethasone dipropionate plus UVB with and without penicillin treatment (5.7 +/- 2.1 and 5.9 +/- 2.5, respectively) declined to 0.5 +/- 0.8 and 1.0 +/- 0.9, respectively, after the therapy. The initial PASI values in generalized psoriasis patients receiving PUVA dropped from 24.1 +/- 3.6 to 1.7 +/- 1.5 by the end of the therapy. Finally, pre-treatment PASI values in patients with generalized psoriasis receiving retinoids decreased from 24.6 +/- 3.5 to 0.9 +/- 1.1 after treatment. However, patients receiving systemic retinoids for generalized psoriasis had statistically higher incidence of side effects than patients receiving PUVA therapy (t = 6.458, df = 38, p < 0.001). CONCLUSION Penicillin should be applied in addition to local corticosteroids with UVB in the treatment of guttate psoriasis, since the disease may be triggered by a streptococcal infection. In cases of generalized psoriasis vulgaris, PUVA therapy caused fewer side effects than did systemic retinoids.