Intralesional cyclosporine versus dithranol in the treatment of plaque- type psoriasis

Abstract

The elusive etiology and array of clinical presentations of psoriasis justify a myriad of therapeutic modalities designed to provide for the individual patient. Our purpose was to compare the clinical and histopathologic effectiveness of intralesional cyclosporine and dithranol in the treatment of plaque-type psoriasis. In a paired comparison study, 30 patients with psoriasis underwent treatment with cyclosporine intralesionally 3 times weekly in one lesion and dithranol daily in another for up to 4 weeks. Disease activity was assessed by a severity global score and histopathologic evaluations of biopsy specimens before and at the end of treatment. Twenty-five patients had complete clearance of one of the treated sites - in twenty-three, the cyclosporine, treated Site cleared first. The mean global score decreased from 14.7 ± 0.5 to 6.0 ±0.8 at the cyclosporine-treated site and 8.7 ± 0.6 at the dithranol-treated site after one week (p < 0.01). The statistically significant difference in favor of cyclosporine was maintained during the first three weeks. Epidermal thickness decreased from 0.39 ± 0.03 mm to 0.22 ± 0.02 at the cyclosporine- and to 0.30 ± 0.03 at the dithranol-treated site (p < 0.01). The degree of dermal infiltration was reduced from 1.77 ± 0.11 to 1.27 ± 0.09 with cyclosporine and to 1.53 ± 0.13 with dithranol (p < 0.01). Mean remission periods for cyclosporine- and to dithranol-treated sites were 316 ± 43 and 210 ± 40 days, respectively (p < 0.01). Intralesional cyclosporine proved clinically and histopathologically more effective than dithranol in the treatment of plaque-type psoriasis.