| Psoriasis is an inflammation,immune-mediated disease that is more common in chronic diseases of the dermatology department.The prevalence of the disease is high.In recent years,the prevalence rate in China has increased to 0.47%.Various factors including race,geographical location,genetic,biochemical,psychological and environmental factors can affect the incidence of psoriasis.According to the clinical features of psoriasis,psoriasis can be divided into vulgaris,pustular,erythrodermic and arthritic types.Irregular treatment often leads to the transformation of vulgaris to pustular and erythrodermic psoriasis.It has a significant impact on the quality of life of patients.Although there are many clinical treatments for psoriasis,there is still no cure for psoriasis.Acitretin is a second-generation retinoic acid derivative widely used in the treatment of moderate to severe psoriasis vulgaris.Methotrexate is an immunosuppressive agent with anti-inflammatory and anti-cell proliferation effects,and shows good curative effect on various types of psoriasis.Although methotrexate is hepatotoxic,it is still a first-line treatment for psoriasis vulgaris and arthritis because of its low cost,convenient use and good curative effect.Although acitretin and methotrexate are commonly used as systemic treatments for psoriasis in clinical practice,the efficacy and side effects of single use of acitretin or methotrexate in the treatment of psoriasis vulgaris are not reported in the literature.In the same way,most doctors worry about the side effects of the two drugs and use them cautiously,thus delaying the treatment of disease.In this study,60 patients with psoriasis vulgaris were randomly divided into two groups,30 in each group.Acitretin or methotrexate was systematically applied in each group to observe its efficacy,side effects,and onset time.Objective:To investigate the efficacy of acitretin and methotrexate on psoriasis vulgaris,and to compare the efficacy,onset time,cost of treatment and side effects of the two drugs in the treatment of psoriasis vulgaris.Methods:1.According to the diagnostic criteria for psoriasis vulgaris,60 patients were diagnosed.Sixty patients were randomly divided into group A and group B,30 cases each.Group A was treated with acitretin capsule orally.The initial dose is 20 mg/d.Group B was given oral methotrexate.The initial dose is 10 mg/week.Thereafter,the dose is increased or decreased depending on the patient’s response to the treatment.Before treatment,4 weeks after treatment,8 weeks after treatment,the PASI score of psoriatic lesions was measured and the therapeutic effect of the two drugs on psoriasis vulgaris was evaluated by calculating the total score decline index.2.Summary and analysis of general information of 60 patients with psoriasis vulgaris.3.Record and compare the onset time of the two drugs.4.Regularly ask and record whether there are adverse reactions(including abnormal blood lipids,liver and kidney dysfunction,skin mucositis,etc.)in the two groups of patients,and analyze the causes,and compare the incidence of adverse drug reactions in the two groups.5.Calculate the cost of treatment of the two drugs for 8 weeks.Results:1)The PASI scores of the two groups of patients with psoriasis vulgaris were significantly decreased after 4 weeks of treatment and after 8 weeks of treatment,and the difference was statistically significant compared with the pre-treatment PASI score.2)The total effective rate of acitretin and methotrexate in patients with psoriasis vulgaris at 4 and 8 weeks was different,but the difference was not statistically significant.3)Adverse reactions: 25 patients in group A developed obvious skin itching,dry eyes,nosebleeds,dry mouth,and dry lips.One patient developed mild dizziness and tinnitus,and one patient developed liver function abnormalities.The incidence of adverse reactions in group A was 90%.Three patients in group B developed abnormal liver function,one had abnormal liver and kidney function,one had dizziness with elevated blood pressure,one had abnormal urine,and one had alopecia.The incidence of adverse reactions in group B was 23.3%.Both groups of patients returned to normal after symptomatic treatment or reduction of the drug.4)The onset time of acitretin was 19.13±12.81 days,and the onset time of methotrexate was 25.67±7.96 days.The difference was statistically significant.5)General information statistics: 60 patients included 32 males and 28 females,aged 16-68 years.The sex ratio of male and female patients was 1.143:1.60 patients with PsV were Han nationality.Rural patients: Urban patients are 29:31,with a degree of education ranging from undergraduate to illiterate,the highest proportion of which is high school or secondary school.The occupational scope is widely distributed,and the largest proportion of them is in the service industry.The first onset age ranged from 8 to 50 years old.Among the 60 patients,the disease originating season was mostly in spring and winter(66.7%).One patient self-reported that skin lesions were significantly associated with the season.The aggravating season is in spring and winter.Skin lesions Symptoms: There are 25 people with a self-conscious symptom,of which 24 people have itching,1 person has a slight tingling sensation in skin lesions;35 people have two or more symptoms,All 35 people have itching.The main symptoms are combined with other symptoms.Other symptoms of skin lesions include swelling,pain,and numbness.The symptoms of skin lesions in 60 patients were mainly pruritus.Among the 60 patients,the first part of the disease was: 16 people on bilateral elbows,15 on heads,7 on calves,5 on backs,5 on the whole bodies,3 on upper arms,3 on thighs,3 on knees,3 on hands and feet.Wrist,limbs,abdomen,joints,chest,buttocks,lower limbs,and trunk are 1 person each.The specific part of 1 person is unknown.Twenty-nine(48.3%)of the 60 patients had no obvious cause of the disease.The remainingpatients consciously have predisposing factors that are clearly associated with onset and exacerbation.The most common ones were colds(13 cases,21.7%),followed by smoking(6 cases,10%),drinking(5 cases,8.3%),mental stress(5 cases,8.3%),food(spicy food,Lamb,seafood)(3 cases,5%),dry environment(1 case,1.7%),humid environment(1 case,1.7%),season(1 case,1.7%),sweating(1 case,1.7%)).Eight patients indicated that a new lesion was formed in the traumatic site.Of the 60 patients with PsV,31 had a history of smoking,and 6 of them said that smoking can aggravate the condition.There are long-term heavy drinking habits(drinking history≥ 10 years,≥ 6 times per week)in 11 cases,accounting for 18.3%.Six patients had exercise habits,which were not related to the development of the disease.Of the60 patients with psoriasis,15 had a family history of psoriasis,accounting for 25%.Among them,11 patients reported that their immediate family members had PsV,3patients reported that their collateral relatives had psoriasis,and 1 patient had self-reported that have both direct and parasitic family members with psoriasis.Only one of the 60 patients had a history of hepatitis B,and the remaining patients were not associated with liver and kidney disease before treatment.The linear regression analysis of DLQI and PASI scores of skin diseases before treatment in 60 patients using SPSS22.0 was performed.F=48.392 P<0.001,the skin quality of life index was linearly correlated with the severity of skin lesions.Corrected R2 = 0.445,and the severity of the lesion(PASI score)explained the 44.5% variation in the skin disease quality of life index(DLQI).The pre-treatment SAS(Anxiety Self-Assessment Scale)standard of 60 patients was 28.97±4.51 points,and after 8weeks of treatment,it was 26.00 ± 1.39 points t=6.241 P=0<0.05.There were statistical differences in SAS standard scores before and after treatment in 60 patients.The pre-treatment SDS(depression self-rating scale)of 60 patients was27.02 ± 3.54 points,and after 8 weeks of treatment,it was 25.63 ± 1.21 points t=4.177 P=0<0.05.The difference of SDS standard scores before and after treatment in 60 patients was statistically significant.6)In this study,patients in the acitretin group who were given drugs for 4 weeks spent 46.5-186.5 yuan.It costs 93-373 yuan to apply the drug for 8 weeks;Patientsin the methotrexate group who were given the drug for 4 weeks spent 10.5-30.5 yuan.It costs 21-61 yuan to apply the drug for 8 weeks.Conclusions:1)A single application of acitretin and methotrexate has a good effect on patients with psoriasis vulgaris.The efficacy of the two drugs after 8 weeks was more significant than that of the 4 weeks.2)Regarding the therapeutic effects of 4 weeks and 8 weeks,there is no difference in the efficacy of methotrexate and acitretin in the treatment of psoriasis vulgaris.3)For psoriasis vulgaris,acitretin has faster onset than methotrexate.4)The incidence of adverse reactions(90%)was higher in the acitretin group than in the methotrexate group(23.3%).The adverse reactions of the two groups of patients were significantly improved after symptomatic treatment or reduction in the dose of the drug.And the adverse reactions occurred in both groups of patients can be reversed. |
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