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ORIGINAL CONTRIBUTIONS
Year : 1990  |  Volume : 56  |  Issue : 3  |  Page : 193-195

Anthrlin short contact therapy in psoriasis




Correspondence Address:
P K Kar


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  Abstract 

Forty cases of psoriasis were treated with dithranol daily for 20 minutes as short contact therapy. The results were compared with another 20 psoriasis patients using dithranol paste as per Ingram technique. Short contact therapy resulted in complete regression in 24 (60%) patients, 90% regression of lesions in 5 (12.5%) patients and deterioration in 2 (5%) cases. The average rate of clearance of lesions was between 10-30 days. Psoriatic lesions disappeared without leaving spotty hyperpigmentation. Dithranol paste as used in the Ingram technique showed complete clearing in 11 (55%) patients, 90% clearing in 5 (25%) cases and deterioration in 4 (20%) patients. Ninety percent cases developed spotty hyperpigmentation and 50% patients experienced marked to fiery red erythema during the course of treatment. Short contact therapy gave minimal side effects and good cosmetic results.


Keywords: Psoriasis, Dithranol, Short contact therapy.


How to cite this article:
Kar P K, Jha P K, Snehi P S. Anthrlin short contact therapy in psoriasis. Indian J Dermatol Venereol Leprol 1990;56:193-5

How to cite this URL:
Kar P K, Jha P K, Snehi P S. Anthrlin short contact therapy in psoriasis. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2020 Jun 2];56:193-5. Available from: http://www.ijdvl.com/text.asp?1990/56/3/193/3522


The application of anthralin for shorter periods followed by deliberate removal of the agent, referred to as short contact therapy, was conceived and introduced by Schaefer et al[1]. The clearing rates of psoriasis are comparable to those of the conventional anthralin therapy and topical corticosteroid therapy[2][,3],[4],[5]. In this study we have compared the efficacy of short contact therapy of dithranol in psoriasis, with the conventional Ingram regime.


  Materials and Methods Top


Sixty patients with stable psoriasis were chosen. Patients having pustular, flexural and erythrodermic psoriasis; and lesions involving axillae, groins, flexural areas, face, scalp and genitals were excluded from this study. All the patients were hospitalised during the course of treatment.

In group I, 40 patients with psoriasis were given short-contact therapy using dithranol incorporated in yellow paraffin base containing 0.5% salicylic acid. Dithranol was used at a concentration of 0.1% for the first 3 days and this concentration was increased to 0.5% and 2% gradually within one week depending on the anti-psoriatic response and the degree of appearance of erythema. The aim was to achieve minimal erythema and pigmentation of the uninvolved skin. The medicine was applied on the lesions for 20 minutes daily after which it was removed with bland coconut oil followed by a soap and water bath. Subsequently, the patients were advised to relubricate the skin with vaseline.

In group II, taken as control, 20 patients were treated as per the standard Ingram technique using topical application of 0.5% to 1 % dithranol paste.

The patients were assessed daily for one week and then twice a week for eight weeks. The degree of scaling, palpability and redness of the psoriatic lesions were recorded. Erythematous reaction and pigmentation of the uninvolved skin were assessed according to a + to +++ scale (+, slight pink erythema; ++, marked erythema; +++, fiery red erythema with oedema; +, slight pigmentation; ++, moderate pigmentation; +++, marked pigmentation).


  Results Top


Out of 40 patients who received short contact therapy, 32 were males and 8 females. The average age of the patients was 32 ± 17 years and the duration of psoriasis was 5 ± 3 years. The affected body area in these patients was 40%'+ 25%. Clearance of lesions occurred between 10-30 days with a mean of about 20 days. Complete clearance of the lesions was achieved in 24 (60%) patients. Five (12.5%) patients showed 90% clearing and 9 (22.5%) patients showed less than 50% clearing [Table - 1].

Short contact therapy was as effective as Ingram technique. In the initial stage however, after 5-10 treatments, Ingram regimen induced marked to fiery red erythema in 50% of the patients [Table - 2] and spotty hyperpigmentation in the uninvolved skin in almost all cases.


  Comments Top


In our study, the duration of illness had no bearing on the clearance of the lesions. Dithranol contact time of 20 minutes proved to be as effective as 24 hours contact of anthralin as used in the Ingram regimen. The Ingram regimen however, induced more frequent side effects than the short contact therapy.

The time taken for the clearance of the lesions in different studies[6] was 26.9 days using 2% dithranol for 20 minutes compared to 24 ± 2 days with 1 % of anthralin in our study. Chattopadhayay et a1[7] used 3% dithranol for'30 minutes and recorded clearance of the lesions in an average of 22.5 days.

The limiting factor in the conventional anthralin therapy is the anthralin induced erythema[8]. The key to safety of short contact therapy of anthralin is the dosimetry to elicit just a faint erythema in the uninvolved skin.

The frequency of side effects with short contact therapy observed in our study was rather low, the most common being pruritus occurring in 15 (37.5%) patients. Localized intense erythema was observed in 8 (20%) patients. Generalized erythema was observed in 2 (5%) cases where anthralin therapy had to be discontinued. Unlike 24-hour application of anthralin in the Ingram regimen, we did not come across any folliculitis after short contact therapy.

In short contact therapy, the concentration of anthralin was riot increased when the erythema exceeded the + scale or when antipsoriatic response was observed, nor was the concentration increased on two consecutive days. Areas with moderate to severe erythema were spared during subsequent days until the erythema subsided. Anthralin was restarted at a lower concentration. Severe erythema was an indication to interrupt the treatment till the erythema faded completely.

 
  References Top

1.Schaefer H, Farber EM, Goldberg L. et al : Limited application period for dithranol in psoriasis, Brit J Dermatol, 1980; 102 : 571-572.  Back to cited text no. 1    
2.Schaefer H : Short contact therapy, Arch Dermatol, 1985; 121:1505-1509.  Back to cited text no. 2    
3.Lowe NJ, Ashton RE, 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. 3    
4.Kaur I, 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. 4    
5.Mac Donald KJS and Marks J : Short contact anthralin in the treat of psoriasis; a study of different contact times, Brit J Dermatol, 1986; 114:235-239.  Back to cited text no. 5    
6.Runne U znd Kunze J : Short-duration (minutes) therapy with dithranol for psoriasis : A new out­patient regimen, Brit J Dermatol, 1982; 106 :135­139.  Back to cited text no. 6    
7.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. 7    
8.Mustakallio KK : Irritation and staining by dithranol and related compounds : I. Estimation with chamber testing and contact thermography, Acta Dermato-Venereol, 1979; 59 : 125-132.  Back to cited text no. 8    


    Tables

[Table - 1], [Table - 2]

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[Pubmed]



 

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