Efficacy of transdermal methotrexate iontophoresis and low dose oral methotrexate in the treatment of palmoplantar psoriasis

Abstract

Background: Psoriasis exclusively involving the palms and soles is known as palmoplantar psoriasis. Though it involves a small body surface area, poses significant morbidity in daily activities of patients. Systemic treatments are indicated for extensive and refractory cases. Systemic toxicity limits the usage of systemic drugs. Methotrexate a time proven drug for psoriasis has been used in oral, injectables and topical formulation. Iontophoresis is a transdermal drug delivery system which can enhance the penetration of methotrexate drug locally, minimizing the systemic side effects. Aim: To evaluate the efficacy of transdermal delivery of methotrexate through iontophoresis in comparison to oral methotrexate in palmoplantar psoriasis. Methods: Forty patients attending the psoriasis clinic with psoriasis involving palms and/or soles are randomly allocated into two groups (20 in each). Methotrexate iontophoresis group was treated with iontophoresis weekly once for 16 weeks whereas oral methotrexate group was given 0.2-0.4mg/kg/week every weekly for 16 weeks. The severity of palmoplantar psoriasis was assessed by mPPPASI at baseline, 4,8,12 and 16 weeks. Results: Males are higher in both study groups. The most common age group of onset was at 40-60 years. Palms and soles was involved in 55%, soles only in 27.5% and palms alone in 17.5%. Mean mPPPASI reduction was gradual in both groups with comparable efficacy. mPPPASI reduction at 16 weeks was higher in Oral methotrexate with good compliance. Conclusion: Methotrexate delivered by Iontophoresis was equally effective as Oral methotrexate in treatment of palmoplantar psoriasis.