IADVL
Indexed with PubMed and Science Citation Index (E) 
 
Users online: 779 
     Home | Feedback | Login 
About Current Issue Archive Ahead of print Search Instructions Online Submission Subscribe What's New Contact  
  Navigate here 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 Resource links
   Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
   [PDF Not available] *
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   Abstract
   Materials and Me...
   Results
   Comments
   References

 Article Access Statistics
    Viewed21165    
    Printed107    
    Emailed2    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal

 


 
ORIGINAL CONTRIBUTIONS
Year : 1990  |  Volume : 56  |  Issue : 1  |  Page : 31-33

Short contact therapy in psoriasis using derobin oinment




Correspondence Address:
Prasanta Basak


Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions

  Abstract 

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[1] to treat chronic plaque psoriasis. With the introduction of short contact therapy (SCT) by Schaefer et al,[2] 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%.[3],[4],[5],[6],[7],[8],[9],[10],[11] 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 Top


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 Top


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 Top


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.[13]

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.[8][11],[12] 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.[13] 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 Top

1.Ingram JT : The approach to psoriasis, Brit Med J, 1953; 2 : 591-594.  Back to cited text no. 1    
2.Schaefer H, Farber EM, Goldberg L et al : Limited application period for dithranol in psoriasis Preliminary report on penetration and clinical efficacy, Brit J Dermatol, 1980; 102 : 571-573.  Back to cited text no. 2    
3.Brun P, Juhlin L and Schalla W : Short contact anthralin therapy of psoriasis with and without UV-irradiation and maintenance schedule to pre­vent relapses, Acta Dermato-Venereol (Stockh), 1984; 64 : 174-177.  Back to cited text no. 3    
4.Hindryckx P and De-Bersaques J : Short duration dithranol therapy for psoriasis, Dermatologica, 1983; 167 : 304-306.  Back to cited text no. 4    
5.Kunze J and Runne U : Left right comparison for the optimal treatment of psoriasis by short-contact ('minutes') therapy with anthralin (dithranol), Acta Dermato-Venereol (Stockh), 1984; 113 (Suppl) : 161-165.  Back to cited text no. 5    
6.Lowe NJ. Ashton RF, Koudsi H et al : Anthralin for psoriasis : Short contact anthralin therapy compared with topical steroid and conventional anthralin, J Amer Acad Dermatol, 1984; 10 : 69-72.  Back to cited text no. 6    
7.Marsden JR, Coburn PR, Marks J et al : Measure­ment of the response of psoriasis to short-term application of anthralin, Brit J Dermatol, 1983; 109 : 209-218.  Back to cited text no. 7    
8.Runne U and Kunze J : Short duration ('minutes') therapy with dithranol for psoriasis : A new out­ patients regimen, Brit J Dermatol; 1982; 106 135-139.  Back to cited text no. 8    
9.Statham BN, Ryatt KS and Rowell NR : Short­contact dithranol therapy-a comparison with the Ingram regime, Brit J Dermatol, 1984; 110 : 703­708.  Back to cited text no. 9    
10.Verschoore M, Archer CB, Petchot-Bacque JP et al : Anthralin short-contact therapy : Clinical response in chronic plaque psoriasis, Acta Dermatol Venereol (Stockh), 1984; 113 (Suppl) : 131-134.  Back to cited text no. 10    
11.Macdonald KJS and Marks J : Short contact anthralin in the treatment of psoriasis, Brit J Dermatol, 1986; 114 : 235-239.  Back to cited text no. 11    
12.Chattopadhyay SP; Aggarwal SK, Arora PN et al Minutes therapy in psoriasis, Ind J Dermatol Venereol Leprol, 1987; 53 : 155-157.  Back to cited text no. 12    
13.Kaur 1, Kaur S, Sharma VK et al : Modified dithranol therapy for psoriasis, Ind J Dermatol Venereol Leprol, 1985; 51 : 90-93.  Back to cited text no. 13    




 

Top
Print this article  Email this article
Previous article Next article

    

Online since 15th March '04
Published by Wolters Kluwer - Medknow