Efficacy of 5-Fluorouracil plus Epinephrine, Pulsed Dye Laser and Betamethasone on the Improvement of Psoriatic Plaques (A Comparative Study)

Background: Many efforts are made to find new and more effective treatments for psoriasis. Intralesional 5-Fluorouracil (5-FU) +epinephrine is a cheap option which can be administered with long intervals. The effectiveness of Pulse Dye Laser (PDL) on psoriasis has been already assessed. We decided to evaluate the effectiveness of 5-FU+epinephrine and compare it to betamethasone and PDL.Methods: A group of 22 patients with chronic stable plaque psoriasis were included. Three plaques on each patient were treated with 5- FU+epinephrine, PDL and betamethasone, respectively. Psoriasis Severity Index (PSI) scoring was applied to assess each plaque before treatment and in weeks 2, 4, 6, 12, and 24. Photos of each plaque were taken before treatment and at each treatment and follow-up session. They were finally compared and scored by a dermatologist.Results: Decline in mean Psoriasis Severity Index (PSI) in week 6 (2 weeks after treatment) and in week 24 (the last follow-up session) was statistically significant as compared to baseline in all groups. (P<0.001) The highest decline in mean PSI score was in the 5-FU+epinephrine group while the lowest belonged to the PDL group (80% vs. 27%).The mean period of remission in the 5-FU+epinephrine group was significantly longer in comparison to the two other groups. (P<0.001) In photographic evaluation, the best response was observed in the 5- FU+epinephrine group.Conclusion: 5-FU+epinephrine is a cheap option which can provide a rapid response and long remission .With respect to limited effectiveness, short remission and high cost; PDL dose not seem to be a preferred choice in the treatment of psoriasis.