Efficacy and Safety of NB-UVB Vs Methotrexate in Chronic Plaque Psoriasis- A Comparative Study

Abstract

Introduction: Psoriasis is a chronic and proliferative inflammatory condition of the skin which is quite common in both sexes. Environmental and genetic factors both are involved in its occurrence. Various topical and systemic treatment modalities are used for psoriasis including methotrexate but phototherapy is also one of the effective treatment modality. Objective: Objective was to compare the safety and efficacy of narrowband ultraviolet B (NB-UVB) and methotrexate (MTX) in chronic plaque psoriasis. Methodology: In this interventional comparative study (Quasi experimental), sixty patients with more than 10% body surface area involved were enrolled according to inclusion criteria and randomly divided into two groups containing even number of patients. In group A patients were given narrowband UVB, three times a week while those in group B were given 15 mg of oral MTX weekly for twelve weeks. The response to the treatment was observed at 4th, 8th and 12th week of therapy and two weeks after stopping therapy. The therapy was considered efficacious in patients when there was ? 50% reduction in the PASI score (Psoriasis Area Severity Index) from baseline. The group in which there was greater mean % reduction in PASI score was considered more efficacious. Results: In group A, NB-UVB was effective in 100% of patients with excellent results in 80% of patients and good results in 20% of patients. Efficacy was seen in 100% of patients in group B with excellent response in 76.66% of patients and good response in 23.34% patients. Side effects were seen in 29.93% of patients in group ‘A’ and 23.34% in group ‘B’. Erythema and tanning were observed in group A while nausea in group B. Conclusion: Narrowband UVB is as good as methotrexate in both safety as well as efficacy in the treatment of chronic plaque psoriasis. Maximum improvement was seen with narrowband UVB during the first month of treatment while with methotrexate, it was seen in the 2nd and 3rd month of therapy. NB-UVB units should be introduced in all government hospitals with dermatology units so that maximum number of patients can be benefited.