Comparison Of The Efficacy On Treating Pediatric Pustular Psoriasis With Acitretin

Background and objective:pustular psoriasis (PP) is a subtype of psoriasis, and it is persistent, and replapsed. Although it’s with low incidence, severe complications were commonly observed, such as, liver and kidney dysfunction may occur, as well as electrolyte imbalance, sepsis, heart failure, et al. Its serious complications is life-threatening. Compared with in adults, pediatric pustular psoriasis is more serious and has more complications. Lower tolerance and cumulative toxicity is generally limits the application of drugs in children. Now, the systemic treatment of children is less consensus, mainly based on clinical experience. Acitretin and Methotrexate (MTX) are both effective method of systemic treatment of psoriasis. MTX’s efficacy has been recognized, as the first-line drug for most severe psoriasis. But for pustular psoriasis, Acitretin is the first-line drug. Recent years, Acitretin has accessed to good effect to treat pustular psoriasis in adult, it had been reported many times. However, Acitretin has little clinical experience in pediatric pustular psoriasis. We have the first chance to compare the efficacy of Acitretin with MTX on treating pediatric pustular psoriasis, and summarize the efficacy of Acitretin, which may provide relevant data for clinical treatment, and a reference for finding the best treatment for pediatric pustular psoriasis.Methods:Clinical data of 32 cases of hospitalized children with PP from December 2006 to December 2014 were collected. The patients’ temperature changes, lesions (including pustules subsided and/or crusting, erythema scaly reduced), side effects of drug, and recurrence of lesions after 3 months discharged were observed.Result:1. Temperature changes after treatmentAll patients were divided into two groups treated with acitretin or MTX respectively. As for duration time from hospitalization to the time when patients’fever declined, no significant difference were observed.As for duration time from hospitalization to the time when patients’ temperature dropped to normal, no significant difference were observed.2. Lesions change① Pustules basically subsided timeThe duration time from hospitalization to the time when pustules disappeared in the group treated with Acitretin was 6.19±3.31 d, the group treated with MTX was 10.10±3.60 d. Compared the two group, the pustules could quickly dry, crust, and disappear in one week in the Acitretin group. The patients of MTX group had slow response, pustules had basically subsided in 10 days (P<0.05).② Time for lesions improvementThe duration time from hospitalization to the time when skin lesion improved≥30%in the group treated with Acitretin was 2.67±1.11 d, the MTX group was 2.64±1.80 d. Compared the two group, no significant difference were observed (P>0.05).The duration time from hospitalization to the time when skin lesion improved≥60%in the group treated with Acitretin was 7.05±3.38 d, the MTX group was 7.10±3.70 d. Compared the two group, no significant difference were observed (P>0.05).The duration time from hospitalization to the time when skin lesion improved≥90%in the group treated with Acitretin was 13.00±4.17 d, the MTX group was 11.70±3.80 d. Compared the two group, no significant difference were observed (P>0.05).③ EfficiencyEffective rate after 1 week treatment in the Acitretin group was 66.7%, and the MTX group was 54.5%(P>0.05). considerring the effective rate in the two groups had no statistically significant difference.Effective rate after 2 week treatment in the Acitretin group was 95.2%, and the MTX group was 90.9%(P>0.05). considerring the effective rate in the two groups had no statistically significant difference.3. Side reactionNo death cases was counted in the two groups. The adverse events happened in 71.4%of the Acitretin group (P<0.05).The incidence of adverse events the Acitretin group was higher than the MTX group, but adverse reactions were mild. Symptomatic treatment could alleviate without reduction or withdrawal.4. RecurrenceWe followed up the cases after discharge, the Acitretin group totally had 16 cases, relapse occurred in 6 patients (37.5%), the MTX group totally had 9 cases, relapse occurred in 4 patients (44.4%), P>0.05, there were no difference between the two groups relapse rate.Conclusion:1. For children with pustular psoriasis, Acitretin compared with MTX, time of pustules subsided was more soon.2. The temperature begined to drop, the temperature had dropped to normal, skin lesions had improved by 30%,60%and 90%of the time spent, the effective rate after one week and two weeks compared to no significant difference between the two drugs.3. The incidence of adverse reactions Acitretin is higher than MTX, but within the prescribed dose response were mild, symptomatic treatment could alleviate without reduction or withdrawal4. The recurrence rate in the Acitretin group and the MTX group had no significant difference in 3 month after the discharge.