Pattern of drug use in the management of psoriasis in a tertiary care hospital: a prospective study
01 Jan 2014-International journal of basic and clinical pharmacology (Medip Academy)-Vol. 3, Iss: 4, pp 611-618
TL;DR: The topical medications induced effective resolution of lesions in most of the patients, along with adequate symptomatic relief, and regular follow-up is required not only to monitor the treatment response, but also to ensure good patient compliance by proper counseling.
Abstract: Background: Psoriasis is a chronic skin disease, characterized by chronic and recurrent scaly plaques with itching. The treatment modalities for psoriasis include topical, systemic, and phototherapy (PT). The pattern of therapy may vary depending upon the type, severity, and duration of the disease. As there are few reports in the Indian literature regarding the pattern of drug use in psoriasis and evaluating the efficacy and patient compliance to treatment, the present study was conducted. Methods: This was a prospective, observational study conducted on121 newly diagnosed and untreated patients with psoriasis, who attended Dermatology outpatient department of a tertiary care hospital. The severity of the disease was assessed by baseline psoriasis area severity index (PASI) score. Most of the patients were treated with topical therapy consisting of glucocorticoids (GC) monotherapy or combination with, salicylic acid, calcitriol and coal tar. Systemic therapy and PT were considered only for severe cases of psoriasis with baseline PASI score >4. The patients were monitored every 2 weeks for 3 months. Results: The topical medications induced effective resolution of lesions in most of the patients, along with adequate symptomatic relief. The response to GC monotherapy was found significant (90.47%; p 4. Regular follow-up is required not only to monitor the treatment response, but also to ensure good patient compliance by proper counseling.
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TL;DR: The differences among clinical varieties in their presenting features, severity, natural course, and response to the treatment are responsible for variation in choice of therapy.
Abstract: Background: Psoriasis is a chronic relapsing disease necessitates long-term therapy. The disease severity, comorbidities, and access to health care determine the choice of therapy for psoriasis. The main aim of the treatment of psoriasis is to induce prolonged remission and suppress the disease as there is no cure. It is only palliative and symptomatic treatment, and the choice of treatment modality is according to the type of presentation. The various modalities of treatment available include topical therapies, systemic therapies, phototherapy, and biologics. The difference includes among clinical varieties in their presenting features, severity, natural course, and response to the treatment are responsible for variation in choice of therapy.Methods: In this descriptive study, data collected from patients diagnosed with psoriasis who were admitted in a K.S. Hegde Charitable hospital from January 2017 to January 2019 were analysed for demographic features, disease pattern and drug use pattern in patients.Results: Psoriasis vulgaris/plaque type of psoriasis was commonly observed type of psoriasis in our patients with fourth and fifth decade patients getting more affected. Diabetes was the most commonly associated comorbid disorder. The patients were treated both with systemic and topical modalities of treatment, antihistaminic and methotrexate were most commonly most commonly used systemic drug and moisturizers and glucocorticoids were used topical drugs.Conclusions: Psoriasis needs a multimodality treatment with careful monitoring for the comorbid disorder. Treatment choice is individualised depending on the severity and body parts affected.
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TL;DR: Proper patient education about the disease, the treatment options, their specific application modality and adverse effects is essential to ensure therapeutic success, and will help alleviate the common problem of poor patient adherence, and inevitably result in more optimal clinical outcomes.
Abstract: Topical therapy forms the cornerstone in the management of psoriasis. Of significant value as monotherapy in mild to moderate psoriasis, it is used predominantly as adjunctive therapy in moderate and severe forms of the disease. Over the past decade, topical treatment of psoriasis has evolved from the age-old applications of tar and dithranol to the more acceptable and efficacious options of topical corticosteroids, retinoids and vitamin D analogues, with the advent of a wide range of appropriately tailored vehicles and sophisticated delivery modes. To ensure therapeutic success, proper patient education about the disease, the treatment options, their specific application modality and adverse effects is essential. This will help alleviate the common problem of poor patient adherence, and inevitably result in more optimal clinical outcomes.
63 citations
TL;DR: While there are very few direct comparison studies between clobetasol propionate in different vehicles, the efficacy rates for more recent formulations are high, with most patients achieving success after 2–4 weeks of treatment in well controlled clinical trials, with response rates that are similar to those with the traditional clobETasol Propionate ointment.
Abstract: Ultrapotent topical corticosteroids are the mainstay of psoriasis treatment, used either alone or in combination with a topical vitamin D analog. Traditionally used in an ointment vehicle for psoriasis, clobetasol propionate 0.05% is also available in spray, foam, lotion, and shampoo formulations, which may provide for improved convenience and acceptance in many patients with similar efficacy, safety, and tolerability as the traditional ointment and cream formulations. To compare newer formulations with traditional ointment and cream formulations, we performed a systematic review of the literature. Search terms included ‘clobetasol propionate,’ in combination with ‘psoriasis,’ ‘vasoconstriction,’ ‘vasoconstrictor,’ or ‘absorption’ for each of the four vehicles (‘spray,’ ‘foam,’ ‘lotion,’ and ‘shampoo’). While there are very few direct comparison studies between clobetasol propionate in different vehicles, the efficacy rates (with success defined as clear or almost clear of psoriasis) for more recent formulations are high, with most patients achieving success after 2–4 weeks of treatment in well controlled clinical trials, with response rates that are similar to those with the traditional clobetasol propionate ointment. Small differences in vasoconstrictor potency or cutaneous absorption have been noted among the formulations, but the clinical significance of these observations is difficult to discern. Recent research has emphasized the importance of treatment adherence in the management of psoriasis. Adherence to treatment is likely to be a far more important determinant of success than are small differences in drug delivery, especially in actual clinical use as opposed to the well controlled environment of clinical trials. For patients who prefer a less messy vehicle, adherence and outcomes are likely to be better with the more recent formulations compared with the traditionally recommended ointment.
44 citations
TL;DR: The present study reconfirms the diagnostic accuracy of silvery white scale, Auspitz's sign, and Koebner's phenomenon in a clinical setting suggestive of psoriasis, but in their absence, histological evidence of suprapapillary thinning and absent granular layer may contribute to the diagnosis of Psoriasis.
Abstract: Background: Psoriasis has different clinical variants, which mimic diverse dermatological conditions and may require a histopathological confirmation of the diagnosis. Studies to establish a clinicohistopathological concordance (and its determinants), in psoriasis and psoriasiform dermatitis are lacking . Aims : The present study was designed (a) to correlate the clinicohistopathological features of psoriasis and psoriasiform dermatitis, and (b) to identify determinant(s) that may contribute to the diagnosis of psoriasis and psoriasiform dermatitis. Methods : This was a prospective study involving 100 patients, with a single clinical diagnosis of psoriasis or with psoriasis as one of the differential diagnoses, and its correlation with histopathological features. Results : The clinical features of typical scale (P = 0.0001) and Auspitz's sign (P = 0.0001), and histological evidence of suprapapillary thinning (P = 0.0001) and absent granular cell layer (P = 0.0001) were found to be statistically significant contributors to the clinicohistological concordance in cases of psoriasis. Vertical orientation of collagen bundles (P = 0.0001) and lymphocytic exocytosis (P = 0.003) were found to be significantly associated with diagnosis of psoriasiform dermatitis. Conclusion : The present study reconfirms the diagnostic accuracy of silvery white scale, Auspitz's sign, and Koebner's phenomenon in a clinical setting suggestive of psoriasis. However, in their absence, histological evidence of suprapapillary thinning and absent granular layer, in addition to the Munro microabscess and Kogoj's abscess, may contribute to the diagnosis of psoriasis. Similarly, vertical orientation of collagen bundles and lymphocytic exocytosis may point toward a diagnosis of psoriasiform dermatitis.
40 citations
TL;DR: The most frequent symptom was pruritus, which was found to be the most common symptom in psoriasis patients, and new scoring systems including symptoms of psOriasis patients may be developed for evaluating the severity of the disease.
Abstract: Background: Pruritus is a common symptom of many dermatological and systemic diseases. It is a common complaint among patients with psoriasis of the chronic plaque type. Patients with pruritus suffer from more severe psoriasis although some authors did not find a significant relationship between pruritus intensity and psoriasis severity. Aims: In this study, we aimed to investigate the relationship between clinical features and symptoms among psoriasis patients. And also we aimed to evaluate whether the severity of disease, depression and quality of life scores could effect these symptoms or not. Methods: Eighty seven patients with psoriasis were enrolled in this study. Epidemiological data of patients were noted. Clinical symptoms, such as pruritus, pain, burning, exudation, bleeding, weakness, etc. were interrogated. The answers to these questions were classified as 'never', 'rare', 'sometimes', 'often' and 'all the time'. Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), Hamilton Anxiety-Depression Scale (HAD) were calculated for each patient. PASI and DLQI scores were classified as ≥ and <10. Results: We found that the most frequent symptom was pruritus (96.6%). Other frequent symptoms were burning (56.3%), exudation (56.3%) and bleeding (49.4%). Hurting, sensitiveness and bothering were more frequent in women. Percentages of hurting, pain, exudation and weakness symptoms had been increasing with age. Frequency of weakness was significantly high in PASI ≥ 10 patients. Conclusion: Pruritus is a very common symptom in psoriasis. Burning, exudation and bleeding are also common symptoms seen in psoriasis. New scoring systems including symptoms of psoriasis patients may be developed for evaluating the severity of the disease.
38 citations
Journal Article•
TL;DR: Clinical and epidemiological data on 782 patients of psoriasis collected from a clinic in north India is presented, finding that there was a male preponderance and Severity of the disease was same in both sexes.
Abstract: Clinical and epidemiological data on 782 patients of psoriasis collected from a clinic in north India is presented. Psoriatics accounted for 1.4% of the total dermatology out-patients. There was a male preponderance. Three fourths of the patients had over 50% involvement of the skin surface. Severity of the disease was same in both sexes. Plaque type disease was commonest in over 90%. Family history of psoriasis was present in 7.40/o-, the age of onset was significantly lower in them as compared to the patients without family history. More than half of the' patients did not experience any seasonal variation. Scalp was the first site of involvement followed by legs and arms. Nails, joints and mucosal involvement were seen in 62.2, 9.7 and 2.3% patients respectively. Pruritus was experienced by 63.5% patients.
37 citations