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KMID : 0363219710090010005
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Korean Journal of Dermatology
1971 Volume.9 No. 1 p.5 ~ p.13
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Effect of Methotrexate and Goeckerman´s Regimen in Treatment of Psoriasis
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김중완/Kim, Joong Wan
김영수/손경애/김정원/Kim, Yung Soo/Shon, Kyung Ae/Kim, Chung Won
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Abstract
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During the last three years, from 1967 to 1970, three hundred and three cases of psoriasis were treated by Goeckrman´s regimen and oral methotrexate, 270 cases and 33 cases respectively. Authors evaluated the clinical effectivness and side effect of methotrexate and it compared with the result of Goeckerman´s method and review about the articles. Of the 303 psoriatics, 140 were male (44%) and 163 were female (55. 6%). The majority of the primary manifestation appeared in 16 to 30 year age group with maximal occurence in the 16 year to 20 year age group (53 cases), but 33 cases were rioted below the 10 years old age(Fig.2). The duration of the disease in most cases was 1 to 10 years,but the highest number, in 72 cases, was 1 to 5 years group (Fig 3A, 3B). 40-cases was in below 6 months.
The methotrexate were administered orally, 2.5 mg. tab., twice daily (5 mg) for 5 to 7 days, followed by 3 to 5 days resting in accordance with the patient´s condittion. The Goeckerman regimen of 2% coal tar and 2% salicylic acid in vaselin applied to whole skin lesions in the night and the excess tar was removed from skin by gentle wiping with a gauze pat, saturated with Arachis oil, in the next morning, followed by ultra-violet ray irradiation for 30 second at first day, then the dose increased 30 second daily to reach 5 min. After the ultra-violet irradiation bath was done, and one hour later 2% coal tar and 2% salicylic acid vaselin were applied again. These schedules were repeated 2 to 3 courses (20 to 30 days) in most cases.
In occasion of Goeckerman treatment, among the completely cleared 93 cases during the preveous treatment, the most cases were recurred within 3 to 12 months but 16 cases within 1 month. In occasion of methotrexate, the lesions recurred within 6 months to 2 years in 17 cases of the 33 cases, but 3 cases were within one month after completely cured preveously. The starting of remission, in Goeckerman methods, was noted within 7 to 14 days in most cases (13 cases), and in 3 cases it started within 3 to 4 days. And the completely clearing of the lesions noted within 20 to 25 days in most cases(16 to 21 cases). The starting of remission, in methotrexate treatment of 33 cases, was occurred within 1 to 2
weeks in most cases(27 cases), and completely clearing of lesions noticed within 14 to 20 days in 28 cases. But in 2 cases it needed only 7 days to make completely clearing the skin lesions.
The side effects of the Goeckerman´s method were as follow :
1) Contact dermatitis due to tar hypersensitivity in 3 cases.
2) Mild local burn due to over dose irradiation . of ultra-violet ray in 5 cases, otherwise no appreciable side effects were noted.
The side effecst of methotrexate were noted in 17 cases among the 33 cases.
1) Aphtous ulcer in 4 cases,
2) Peptic ulcer in one case,
3) Tinitus in one case,
4) Other side effects such as dizziness, loss of appetite, headache, fatiguability were notable in 10 cases.
5) In addition to above mentioned side effects the blood chemistry include L.F.T., wbc count, platelet count, ESR, Hgb, and creatinine showed as follow before and after administration of methotrexate.
a) The white blood cells, platelet count were tend to decrease after the administration of methotrexate than before one.
b) Among 33 cases the SGPT levels were checked in 16 cases, and in most cases it raised more and less than before the administration of methotrexate, but only 8 cases were above the normal ranges(35 units). The SGOT level also raised after one course, but only 3 cases were above normal ranges (40 units):
c) Hgb, ESR, creatinine showed no remarkable changes.
In many references the effects and side effects of methotrexate were discussed, but their view were not uniform and variable. In the clinical improvement, recurrency, and side effects, the large single weekly dose of methotrexate had no fundamental differences compare with the author´s small daily
doses.
We agree with the Ryan´s report(11), in which the large single dose were not always safer and more effective than the small dose. Still there are many important problems to study about the dosage, interval of administration, and resting period in the treatment of psoriasis with methotrexate,
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