A comparison of PUVA-etretinate and PUVA-placebo for palmoplantar pustular psoriasis

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Abstract
Seventeen patients with palmoplantar pustular psoriasis and three with hyperkeratotic psoriasis of palms and soles were treated with either PUVA‐etretinate (1 mg/kg) or PUVA‐placebo. Patients were randomly allocated to each group and the trial was conducted according to a double‐blind protocol, so far as the side‐effects of etretinate made this possible. PUVA was given three times a week for a maximum of 18 weeks, after 2 weeks on daily placebo or etretinate alone. All ten patients in the PUVA‐etretinate group cleared, but there were four failures in the PUVA‐placebo group (P=0.03). The PUVA‐etretinate treated patients required significantly fewer PUVA treatments (13.1 ± 2.9; mean ± s.e.) and cleared in a significantly shorter time (30.3 ± 7.1 days) than the PUVA‐placebo group (23.2 ± 4.2 treatments; 59.2 ± 11.5 days, P < 0.05). The cumulative UV‐A dose to clear was less in the PUVA‐etretinate group (53.9 ± 18.5 J/cm2) than the PUVA‐placebo group (113.1 ± 33.4 J/cm2). This difference was not significant due to the exceptionally large dose of UV‐A used on one patient but the results were significant when it was excluded. The therapeutic advantage of adding etretinate to PUVA is offset by the side‐effects of cheilitis, hair loss and peeling skin which occurred in eight of the ten PUVA‐etretinate patients, and an increase in fasting triglyceride concentrations and serum alkaline phosphatase activity.