|Year : 1990 | Volume
| Issue : 1 | Page : 31-33
Short contact therapy in psoriasis using derobin oinment
Prasanta Basak, Surrinder Kaur, Inderjeet Kaur
Source of Support: None, Conflict of Interest: None
Derobin ointment was used for a short contact period of 30 minutes a day for the treatment of 12 patients with chronic plaque psoriasis. Full strength Derobin ointment (containing 1.15% dithranol)was used on the lesions situated on the left side, while the right side lesions were treated with Derobin oitnment diluted with yellow soft:paraffin to a concentration of 0.5% dithranol. At the end of 6 weeks, 75% patients completely cleared using either strength of Derobin. Pigmentation of the peri-lesional skin and irritation were minimal with the diluted formulation.
Keywords: Psoriasis, Short contact therapy, Dithranol
|How to cite this article:|
Basak P, Kaur S, Kaur I. Short contact therapy in psoriasis using derobin oinment. Indian J Dermatol Venereol Leprol 1990;56:31-3
|How to cite this URL:|
Basak P, Kaur S, Kaur I. Short contact therapy in psoriasis using derobin oinment. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2019 Aug 21];56:31-3. Available from: http://www.ijdvl.com/text.asp?1990/56/1/31/3475
Dithranol (1, 8, 9-trihydroxyanthracene) was used successfully by Ingram in 1953 to treat chronic plaque psoriasis. With the introduction of short contact therapy (SCT) by Schaefer et al, the side effects of irritation and staining of the skin by dithranol were minimized while the therapeutic efficacy was maintained. Subsequent workers have documented the effectiveness of SCT using dithranol in an ointment base with concentrations ranging from 0.25% to 8%.,,,,,,,, The contact time in these studies varied from 10 to 60 minutes per day. We report here a comparison of the therapeutic efficacy of dithranol using full strength Derobin ointment (Dithranol 1.15% w/w; salicylic acid 1.15% w/w; solution of coal tar 5.3% w/w in soft paraffin base) applied on the left side of the body, while the right side was treated with the Derobin ointment diluted with yellow soft paraffin to 0.5% dithranol.
| Materials and Methods|| |
Twelve patients, 8 males and 4 females with ages varying from 14 to 60 years (mean 34.5 years), diagnosed as chronic plaque psoriasis and having symmetrical lesions were selected.
Most of the patients had been treated earlier with coal tar or topical corticosteroids for 1 to 3 years without complete remission. None of the patients were previously taking oral corticosteroids or immunosuppressive drugs. All oral and topical drugs were stopped 2 weeks prior to the study and patients were instructed to apply only coconut oil on the plaques as an emollient during the period of study.
The ointment was applied with the fingertips strictly on the plaques and kept for a contact period of 30 minutes each day, after which it was removed thoroughly with soap and water.
Patients were examined daily and the findings recorded on day 1 (i.e. on the day of starting the therapy), 7, 14, 21, 28 and at the end of 6 weeks if the lesions persisted that long. The clinical parameters for assessment were erythema, scaling, induration and pruritus, graded + to + + 4 according to the severity(mild, moderate or severe). The end point was lack of palpability and scaling of the plaques.
No ultraviolet light (UVL) or tar baths were used during this period. Since dithranol stains linen, patients were asked to wear old garments during the contact period. Each patient was observed for irritation from dithranol. Redness, discomfort and tenderness of the skin surrounding the psoriatic plaques were also looked for.
Paired student `t' test was used to evaluate the data.
| Results|| |
Nine (75%)out of 12 patients cleared completely within 42 days using either concentrations. With full strength Derobin ointment, the mean time for clearing of the lesions was 34.2 days and that for the diluted strength was 37.3 days.
However, this difference was statistically not significant.
The improvement in pruritus with full strength Derobin ointment was the same as compared to the diluted strength upto the second week of therapy. Thereafter, the patients treated with the diluted formulation experienced significantly less pruritus. No patient had to be withdrawn from therapy due to the irritant effect of Derobin. Brownish staining of the clothes and peri-lesional skin occurred with both the concentrations and the lesions resolved leaving behind hypopigmented macules.
| Comments|| |
Graded strengths of dithranol (Derobin ointment) diluted in yellow soft paraffin applied overnight in concentrations ranging from 0.05% to 1.0% o dithranol, according to tolerance, followed by exposure to sunlight daily for 16 weeks led to complete clearance in 54% of patients.
Our study with SCT using Derobin ointment resulted in complete clearance in 75% of the patients in 6 weeks without using sunlight or UVL. Using dithranol (1%) with salicylic acid (I %) for a contact period of 60 minutes per day, Schaefer et ah reported complete clearance in 23% of his patients in 4 to 6 weeks. Brun et al 3 observed clearance in 82.5% of patients in 5 weeks using 0.2% to 1 % dithranol in combination with 2% salicylic acid and a contact time of 10 to 20 minutes. Complete clearance in 46.6% cases was observed by Chattopadhyay et al 7 using 1 to 3%, dithranol with 3% salicylic acid for 10 to 30 minutes each day.
Using full strength Derobin ointment (1.15% dithranol) and the diluted ointment (0.5% dithranol), the mean clearing time in our study _ was 34.2 days and 37.3 days respectively. Using graded strengths of dithranol (1 to 3%) for variable contact periods (10 to 20 minutes per day), other investigators observed that the average time taken for complete clearance of the lesions ranged from 22 to 27 days., However, in the above studies, salicylic acid was added to dithranol to act as an antioxidant, which by virtue of its keratolytic effect served to hasten the clearing.
Psoriatic plaques on the upper limbs are reported to clear earlier than those on the lower limbs, and lesions on the knees and elbows are believed to respond slowly to therapy. However, we found no significant difference in the clearing time of lesions situated in the above mentioned areas.
Dithranol is commercially available in India as Derobin ointment (Allenburys). Both the full strength and the diluted formulation of Derobin are equally effective, but in practice diluting the ointment with yellow soft paraffin requires technical skill which may not be possible for patients to acquire. The ease of application in SCT, together with the short contact time is convenient for patients -receiving treatment as outpatients. This mode of therapy is cheap and the only side effects are manageable.
| References|| |
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