A comparative study on therapeutic efficacy between methotrexate iontophoresis and topical methotrexate 1% gel in palmoplantar psoriasis

Abstract

Palmoplantar psoriasis is a disease which often leads to disfigurement and disability. It is resistant to conventional therapy where systematic therapy mostly with methotrexate is indicated. To overcome systemic toxicity of the drug, topical delivery methods has been tried recently with unsatisfactory results because of its poor penetration. Iontophoresis may help to increase its absorption and thereby efficacy. Our study included a total of 60 patients fulfilling the selection criteria. They were randomly divided into two groups, group A & group B; comprising 30 patients in each. The patients in Group A received topical methotrexate 1% gel twice daily treatment for 8 weeks on all days. The patients in Group B underwent methotrexate iontophoresis once in a week for 4 weeks followed by every two weeks. A total of six session of iontophoresis was done and both groups were followed up for another 3 months. Evaluation of therapeutic efficacy was done by assessing the lesions for erythema, scaling and fissuring during each visit and follow up period. Overall improvement in group A and group B were 82.4% and 95.3% respectively. Recurrence rates were nearly similar in both groups. There was highly statistical significant improvement and clearance rates with group B at the end of 8 weeks of therapy and after follow up period compared to group A (p value < 0.01).