Medknow Publications on behalf of The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL)
Abstract
Background: Methotrexate is the drug of choice in extensive psoriasis
in developing countries. In patients who can not take methotrexate
either due to intolerance or concomitant liver disease, there is an
urgent need for an alternative affordable and accessible drug. Aims: To
evaluate the therapeutic efficacy and safety of hydroxyurea as an
alternative in the management of patients with extensive psoriasis.
Methods: A prospective study was carried out over 16 months on 34
patients with chronic plaque psoriasis (>20% body surface area
involvement), erythrodermic or generalized pustular psoriasis who were
partially responsive or non-responsive to the conventional topical and
systemic modalities of therapy. Besides doing a baseline hemogram,
liver and renal function tests, and urine analysis, these tests were
frequently repeated during the course of therapy. Hydroxyurea was
started at 1 g daily and increased to 1.5 g, if required. The
therapeutic response was evaluated by a global assessment made by the
patient and physician and regular PASI scoring. Results: Good to
excellent response was observed in 25 (73.5%) patients, less than 50%
response in 7 (20.6%) patients, while 2 (5.9%) patients were lost to
follow up. The mean PASI score was reduced by 76% at 10-12 weeks.
Therapy was discontinued in 3 patients due to leukopenia that recovered
on discontinuation of hydroxyurea. Patients were followed up to 1 year
and relapse was observed in 5 patients. The duration of remission
varied from 6 months to 1 year. Conclusion: Hydroxyurea is an effective
and reasonably safe second line agent for psoriasis