Comparison of effectiveness and safety of excimer lamp versus topical calcipotriol-clobetasol propionate combination in the treatment of palmoplantar psoriasis

Abstract

Background

Very few studies have assessed the efficacy of excimer treatment in palmoplantar psoriasis (PPP), and none has compared the excimer with calcipotriol-clobetasol combination.

Purpose

To compare the effectiveness and safety of excimer lamp versus topical ointment containing calcipotriol (0.005% w/w) and clobetasol propionate (0.05% w/w) combination in PPP.

Methods

This right-left randomization trial included 36 patients with PPP, who received treatment with excimer lamp (twice weekly) on one side and calcipotriol-clobetasol combination once daily on another side for 12 weeks, followed by 8 weeks follow-up. Recruitment and response assessment was done by 2 experienced dermatologists (SD and TN) using modified palmoplantar pustular psoriasis area and severity index score (m-PPPASI, originally devised for palmoplantar pustulosis, suitably modified to assess response in PPP).

Primary outcome measure was percentage improvement in mPPPASI at 12 weeks, which was classified as minimal (≤ 25%), mild (>25-50%), moderate (>50-75%) and marked (>75%). The secondary outcome measures were the proportion of patients achieving >75% reduction in m-PPPASI and the time to achieve it.

Results

Of 36 recruited patients, 33 completed treatment and 21 adhered to 8-weeks follow-up. The mean mPPPASI on the excimer treated sides reduced significantly from 7.75 ± 4.62 to 4.01 ± 4.07 (p < 0.001) at 12^th week (end of the treatment) and 2.66 ± 3.97 at 20^th week (at 8 weeks follow-up). The mean mPPPASI on the calcipotriol-clobetasol treated sides reduced significantly from 7.36 ± 4.46 to 3.55 ± 3.77 (p < 0.001) and 2.70 ± 3.97 at 12^th week and 20^th week respectively. The reduction was significant for both treatment modalities. The difference between the two modalities was not significant.

Minimal, mild, moderate and marked improvement was seen in 5/33 (15.2%) and 1/33 (3.0%), 6/33 (18.2%) and 8/33 (24.2%), 12/33 (36.4%) and 13/33 (39.4%), and 8/33 (24.2%) and 8/33 (24.2%) sides in the excimer and calcipotriol-clobetasol combination respectively. A total of 8 patients in each group achieved mPPPASI 75 at 12 weeks. The mPPPASI 75 was achieved at 2, 4 and 8 weeks in 1, 2 and 8 patients respectively using either modality. The adverse effects (most commonly hyperpigmentation) were noted more on the excimer-treated sides, however they were well tolerated.

Conclusion

Both excimer lamp and calcipotriol-clobetasol combination are equally effective in treatment of PPP.

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