Methotrexate-puvasol combination in treatment of psoriasis

Abstract

Patients with severe psoriasis were divided into 2 groups. In group A, consisting of 30 patients, remissions were induced by short term use of combination therapy consisting of methotrexate (5 mg every 12 hours x 3 doses per week) + psoralen (30 mg on alternate days) and sun exposure (PUVASOL). Thereafter, remission was maintained by use of minimal possible PUVASOL treatment alone. However, flare-ups during maintenance-phase were controlled by short term addition of methotrexate. Remission was induced in all these cases after a mean of 5.1 weeks (range, 3 - 9 weeks) of treatment using a mean total dose of 74.6 mg of methotrexate along with PUVASOL. During maintenance phase, recurrence was observed in 19 of these patients after a mean of 4.6 months. These recurrences were again controlled by clearance courses of methotrexate. On an average 1 - 6 (mean, 4) clearance courses were required during a period of 2 years.
In group B, consisting of 10 patients, remission was induced by use of methotrexate alone and after achievement of remission methotrexate was withdrawn. Comparatively I did not find any significant advantage of adding PUVASOL for clearance of the lesions. However, during follow-up all patients in group b reported with recurrence much earlier. I recommend the use of methotrexate alone for clearance of lesions in severe psoriasis and PUVASOL alone in maintenance phase to prevent relapse.