INTRODUCTION :
Psoriasis is a common, genetically determined, inflammatory and
proliferative disease of the skin. The most characteristic lesions consist of
red, scaly, sharply demarcated, indurated plaques present particularly on the
elbows, knees, lowerback, extensor surfaces and scalp.
The first recognisable description of psoriasis is attributed to Celsus
(25BC-45AD) in his de re medica nearly 2000 years ago. The disease was
described under the heading of impetigo from the Latin word impeto which
means "to attack or rush on" Galen was the first to use the word psoriasis
from the Greek work 'psora' which means 'to itch'. Psoriasis and Leprosy
were grouped together for centuries. Willan was the first to accurately
describe psoriasis and its various manifestations in 1809, but he did not
separate it with certainty from Leprosy. In 1841, Hebra definitively
distinguished the clinical picture of psoriasis from that of Hansen's disease.
Eventhough a number of treatment modalities are available, psoriasis
continues to be a therapeutic challenge in spite of our growing knowledge
of its pathogenesis.
AIM OF THE STUDY :
Palmoplantar psoriasis is a chronic disease with remissions and
exacerbations. Most of the topical therapies currently available for psoriasis
are either suited for short term therapy or long term maintenance therapy.
Furthermore topical corticosteroids commonly used for palmplantar
psoriasis, show diminished response on continuous use due to tachypylaxis
and more incidence of recurrence.
OBJECTIVE :
To compare the efficacy of various topical therapies like
Short contact compound dithranol ointment (dithranol 1.15%, salicylic acid
1.15%, coal tar solution 5.3% in white soft paraffin)
Topical 0.1% Betamethasone valerate ointment
Topical tazarotene 0.05% gel
Topical PUVA using -1% methoxypsoralen solution
Liquid paraffin.
CONCLUSION :
Topical therapies are the first line therapeutic strategy in the treatment
of localized palmoplantar psoriasis and can be made effective when the
appropriate drugs were used judiciously.
Among the five modalities compared in this study, tazarotene (0.05%)
gel may be considered as an initial treatment of choice.
Topical PUVA is as effective as tazarotene except for the limiting
factors for PUVA therapy such as availability of PUVA unit, patient
compliance and long term side effects.
Topical dithranol is as effective as topical PUVA when used as
20minutes short contact therapy.
Topical 0.1% Betamethasone valerate was moderately effective with
frequent exacerbation.
Liquid paraffin was the least effective with no adverse effects, no
exacerbation and remissions. However it can be used as an adjunct with
other topical therapies
