Combination therapy and the use of an initial dose of intramuscular methotrexate in patients hospitalized for psoriasis

Abstract

Standardized inpatient treatment regimens for recalcitrant psoriasis typically require over 2 weeks of hospitalization. Different therapeutic strategies should be sought in an effort to shorten hospitalizations and contain health-care costs. We utilized a combination of multiple treatment modalities in an attempt to shorten hospital stays for severe psoriasis. We further studied whether a single initial intramuscular injection of methotrexate could safely enhance the speed of clearance. A group of 34 evaluable patients hospitalized for psoriasis were given a combination of oral etretinate, ultraviolet B radiation treatments, whirlpool baths, topical emollients, and either topical crude coal tar or topical triamcinolone ointment. Patients were also prospectively studied in a double-blind, placebo-controlled fashion to determine the effect of an initial intramuscular injection of methotrexate. Psoriasis severity and area indices (PASI), number of hospital days, toxicity, and rebound after discharge were monitored. The average number of hospital days required to achieve a 50% reduction in the PASI was 9.00. Patients who received methotrexate had a significantly shorter hospital stay (8.06 days) than those who received placebo (9.94 days; P = 0.03). Toxicity was transient and early rebound was incidental. Combination therapies for patients hospitalized with psoriasis appear to be safe and may shorten hospital stays.

Key Words:

• Psoriasis
• Intramuscular methotrexate
• Combination therapy