Comparative Study of Efficacy of Various Topical Treatment Modalities for Psoriasis

Aim of the study : To compare the efficacy and tolerability of various topical therapies like short contact Lipsomal dithranol ointment, 0.1% Betamethasone valerate ointment and liquid paraffin for psoriasis. Materials and Methods: This study was conducted in dermatology department of a tertiary hospital and a total of sixty patients who attended the Psoriasis clinic were randomly allocated to 3 groups ( 20 patients each) to receive short contact liposomal dithranol ointment, 0.1% Betamethasone valerate ointment and liquid paraffin after the diagnosis of psoriasis was made on clinical grounds and histopathological examination. Results: Among the sixty patients included in the study the mean age in our study was 37.43 with males outnumbering the females in each of the three groups. The mean duration of psoriasis was 41.24 months. The clinical types of Psoriasis in our study was plaque type (42) followed by palmoplantar (11) and guttate type (7). Family history was present among 3% of the total patients. Nail changes was present in 28 patients. Joint involvement was present in 6 patients. The mean baseline PASI scores in the lipsomal Dithranol ointment, 0.1% Betamethasone valerate ointment and liquid paraffin were 5.36, 4.82 and 4.23. At the end of 4 weeks the PASI scoring has reduced to 1.97 (64%) , 1.76 (65/%) and 3.97 (4%) and by the end of 8 weeks the PASI scoring has reduced to 0.97 (83%), 0.93 (83%) and 3.94 (6%) respectively for the above mentioned groups. At the end of 12 weeks the liposomal Dithranol and Betamenthasone groups showed a sustained reduction in PASI score to 0.91 (84%) and 0.78 (85%) respectively and no reduction in PASI 3.92 (6%) for liquid paraffin group. Conclusion: Among the three modalities compared in the study the effectiveness of topical lipsomal dithranol is equivalent to the of betamenthasone valerate in plaque type of psoriasis. Liposomal dithranol produces only moderate results in the treatment of Palmoplantar psoriasis when compared to betamethasone valerate. Topical betamethasone group had frequent exacerbations when compared to Liposomal dithranol group. The adverse effects like irritation and staining were minimal with liposomal dithranol preparation and was rapidly reversible. The liquid paraffin group was the least effective with neither adverse effects nor exacerbation and remissions.