Addition of 308-nm Excimer Laser to Acitretin Therapy in the Management of Palmoplantar Psoriasis

This open label study evaluated whether a reduction in acitretin dose from 25 mg/day to 17.5 mg/day in patients with severe plaque-type psoriasis undergoing phototherapy treatment improved tolerability while maintaining comparable efficacy.

At baseline, subjects were switched from 25 to 17.5 mg acitretin daily and followed for 12 weeks.

Efficacy evaluations were performed through week 12. The psoriasis area-and severity index (termed PASI) combines assessments of the extent of body-surface involvement in four anatomical regions (head, trunk, arms, and legs) and the severity of desquamation, erythema, and plaque induration (thickness) in each region, yielding an overall score of 0 (no psoriasis) to 72 (severe disease). The physician's global assessment rates the patient's psoriasis overall relative to baseline as 1 (clear), 2 (excellent), 3 (good), 4 (fair), 5 (poor), or 6 (worse) and considers involvement of body surface area (BSA), induration, scaling, and erythema. The 10-item Dermatology Life Quality Index questionnaire, completed by the subject, measures whether psoriasis has an effect on the subject's quality of life, with scores ranging from 0 ("no effect") to 30 ("extremely large effect"). The 15-item Psoriasis Disability Index (PDI), completed by the subject, measures the level of impairment psoriasis has on quality of life, with scores ranging from 0 ("no effect") to 45 ("extremely impaired"). Subjects also completed a subjective assessment of efficacy of the reduced dose of acitretin at week 12 of the study by answering the question "How was your psoriasis over the last 3 months?", with answers ranging from better than before, the same as before, or worse than before.

The safety and tolerability was assessed for the reduced acitretin dose by monitoring adverse events and routine laboratory values through week 12. Serum samples collected at baseline and week 12 were tested for LFTs, lipids, CBC, and chemistry panel. Subjects also completed a subjective assessment of tolerability of the lower dose at week 12 of the study by answering the question, "Did your symptoms from the medicine you noted above improve over the last 3 months?", with answers ranging from better than before, the same as before, or worse than before.