Podophyllin (10%) Ointment: A New Therapeutic Modality for Psoriasis

Khalifa E. Sharquie, Adil A. Noaimi, Wesal K. Al-Janabi

Department of Dermatology & Venereology, College of Medicine, University of Baghdad, Baghdad, Iraq.
Department of Dermatology and Venereology, Baghdad Teaching Hospital, Baghdad, Iraq.
Scientific Council of Dermatology & Venereology, Iraqi Board for Medical Specializations, Department of Dermatology & Venereology, College of Medicine, University of Baghdad, Baghdad, Iraq.

DOI: 10.4236/jcdsa.2013.34037                

Abstract

Background: There are many topical therapies for the treatment of plaque psoriasis like steroid, dithranol, tar and vitamin D analogues, but none of them is ideal. Most recently, in a pilot study, podophyllin 5% ointment on every other day regimen was as effective as clobetasole 0.05% ointment twice daily. Objective: To reassess the efficacy of a higher concentration of podophyllin (10%) in the treatment of mild psoriasis in comparison with clobetasole using a different regimen. Patients and Methods: This is therapeutic, comparative, placebo-controlled study conducted at the Department of Dermatology-Baghdad Teaching Hospital, during the period of January 2011 - October 2012. Eighty-seven patients with mild plaque-type psoriasis were divided into three groups: Group A (30) patients were treated with podophyllin 10% ointment; Group B (30) patients were treated with clobetasol propionate 0.05% ointment and Group C (27) patients were treated with Vaseline as a placebo control group. All patients were treated on every other day. The efficacy was evaluated every 2 weeks for 8 weeks using PASI score and the local and systemic side effects were recorded. The relapse was recorded after cessation of therapy in those patients who achieved good response during another 8 weeks follow-up period. Results: The patients were 60 (68.9%) males and 27 (31.1%) females (male: female ratio, 2.2:1). Their ages ranged from 18 - 62 (36.4 ± 10) years. Their disease duration ranged from 0.1 - 40 (7.8 ± 8.5) years. Their baseline PASI score ranged from 1.6 - 9.6 (4.4 ± 5.85). At the end of 8th week of therapy, Group A patients had achieved much higher reduction in PASI score (77.4 ± 14.1) than Group B patients (60.4 ± 27.8), P value = 0.004, and both of them were with statistically and significantly higher PASI reduction than patients in Group C (28 ± 23.4), P value = <0.001. The total relapse rate during 8 weeks follow-up was much lower among Group A treated patients, 20% versus 66.6% in Group B (P-value = 0.002), while the relapse rate was 100% in the Group C patients. Regarding side effects: 3 (10%) patients developed erythema, burning, pain, blistering and hypopigmentationin Group A. No side effects were reported in Groups B nor C patients with no statistically significant difference among the three groups (P = 0.052). Conclusion: Podophyllin 10% ointment was more effective than clobetasole 0.05% ointment on every other day treatment regimen at the end of 8 weeks treatment with no side effects and a much lower relapse rate in treatment of mild plaque-type psoriasis.

Keywords

Podophyllin; Psoriasis; Iraqi Patients; Every Other Day Therapy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	C. E. M. Griffith and J. N. W. N. Barker, “Psoriasis,” In: T. Burns, S. Breathnach, N. Cox and C. Griffiths, Eds., Rook’s Textbook of Dermatology, 8th Edition, Wiley-Blackwell Publishing Company, Singapore, 2010, pp. 871-930.
[2]	E. G. Johann and T. E. James, “Psoriasis,” In: K. Wolf, L. A. Goldsmith, S. I. Katz, B. A. Gilchrest, A. S. Paller and D. J. Leffell, Eds., Fitzpatrick’s Dermatology in General Medicine, 7th Edition, Mc Graw Hill, New York, 2008, pp. 169-193.
[3]	E. C. Martin, L. Christy, M. C. Cowan, S. W. Marshal, A. H. Dawson, S. A. Seifert, W. S. Schon, L. Yip, D. C. Keyes, K. M. Hurlbut and R. C. Erdman Arm Dart, “Medical Toxicology,” 3rd Edition, Walters Kluwer Company, Philadelphia, 2004, pp. 1690-1701.
[4]	D. G. Olsen and R. C. Dart, “Skin and Mucous Membrane Agents,” In: Medical Toxicology, 3rd Edition, Walters Kluwer Company, Philadelphia, 2004, pp. 1003-1004.
[5]	K. E. Sharquie, M. M. Al-Waiz and A. A. Al-Nuaimy, “Condylomata Acuminate in Infants and Young Children. Topical Podophyllin Is an Effective Therapy,” Saudi Medical Journal, Vol. 26, No. 3, 2005, pp. 502-503.
[6]	K. E. Sharquie, A. A. Noaimi and A. G. Al-Ghazzi, “Treatment of Cutaneous Leishmaniasis by Topical 25% Podophyllin Solution (Case-Controlled Study),” Thesis, Iraqi Board for Medical Specializations in Dermatology and Venereology, Baghdad, 2010.
[7]	K. E. Sharquie, A. A. Noaimi and M. S. Al-Zoubaidi, “Treatment of Basal Cell Carcinoma by Topical 25% Podophyllin Solution,” Thesis, Iraqi Board for Medical Specializations in Dermatology and Venereology, Baghdad, 2012
[8]	K. E. Sharquie and A. A. Noaimi, “Basal Cell Carcinoma: Topical Therapy versus Surgical Treatment,” JSSDS, Vol. 16, No. 2, 2012, pp. 41-51.
[9]	K. E. Sharquie and L. H. Al-Taha, “Podophyllin (25%) as a Topical Therapy for Genital Warts in Pregnant Women,” Medical City & College of Medicine-Baghdad Joint Conference, Baghdad, 24 December 2012.
[10]	K. E. Sharquie, A. A. Noaimi and W. K. Al-Janabi, “Efficacy and Safety of Topical Podophyllin 5% Ointment in Patients with Mild Plaque-Type Psoriasis,” The Iraqi Postgraduate Medical Journal, Vol. 12, No. 2, 2012, pp. 251-258.
[11]	C. S. Carlin, S. R. Feldman, J. G. Kruger, A. Menter and G. G. Krueger, “A 50% Reduction in Psoriasis Area and Severity Index (PASI) Is a Clinical Significant End Point in the Assessment of Psoriasis,” Journal of the American Academy of Dermatology, Vol. 53, No. 6, 2005, pp. 547-551.
[12]	K. I. Al-Hamdi and L. Al-Kinani, “Treatment of Psoriasis with Zinc Sulphate Cream 2.5% in Comparison with Clobetasol Propionate Cream,” Thesis, Iraqi Board for Medical Specializations in Dermatology and Venereology, Baghdad, 2006.
[13]	K. B. Gordan, T. Rolstad and G. Krueger, “Definitions of Measures of Effect Duration for Psoriasis Treatments,” Archives of Dermatology, Vol. 141, No. 1, 2005, pp. 82-84. http://dx.doi.org/10.1001/ archderm.141.1.82
[14]	J. C. Sterling, “Virus Infections,” In: T. Burns, S. Breathnach, N. Cox and C. Griffiths, Eds., Rook’s Textbook of Dermatology, 8th Edition, Wiley-Blackwell Publishing Company, Singapore, 2010, pp. 1489-1566.
[15]	United State Pharmacopeia Committees, “Podophyllin,” In: Drug Information for the Health Care Professional, 24th Edition, Rev. US Convention Inc., Thomason Micromedex, 2004, pp. 2341-2348.
[16]	W. G. Douglas, Y. Poulin and J. Decroix, “A New Calcipotriol/Betamethasone Formulation with Rapid Onset of Action Was Superior to Monotherapy with Betamethasone Diproprionate or Calcipotriol in Psoriasis Vulgaris,” Acta Dermatovenerologica Croatica, Vol. 82, No. 2, 2002, pp. 131-135.
[17]	G. L. Colombo, S. Di Matteo, G. Bruno, G. Girolomoni and G. A. Vena, “Calcipotriol and Betamethasone Dipropionate in the Treatment of Mild-to-Moderate Psoriasis: A Cost-Effectiveness Analysis of the Ointment versus Gel Formulation,” ClinicoEconomics and Outcomes Research, Vol. 4, 2012, pp. 261-268.
[18]	F. Matthew, H. Yolanda and K. Sewon, “Other Topical Medications,” In: J. L. Bolognia, J. L. Jorizzo and V. S. Julie, Eds., Dermatology, 3rd Edition, Mosby Elsevier, New Haven, 2012, pp. 2153-2164.
[19]	C. R. Darley, W. J. Cunliffe and C. M. Green, “Safety and Efficacy of Calcipotriol Ointment (Dovonex) in Treating Children with Psoriasis Vulgaris,” British Journal of Dermatology, Vol. 135, 1996, pp. 390-393. http://dx.doi.org/10.1111/j.1365-2133.1996.tb01501.x
[20]	J. B. Jones, “Topical Therapy,” In: T. Burns, S. Breathnach, N. Cox and C. Griffiths, Eds., Rook’s Textbook of Dermatology, 8th Edition, Wiley-Blackwell Publishing Company, Singapore, 2010, pp. 3841-3892.
[21]	M. Prins, O. Q. J. Swinkels and Van de Kerkhof, “The Impact of the Frequency of Short Contact Dithranol Treatmen,” European Journal of Dermatology, Vol. 11, No. 3, 2001, pp. 214-218.
[22]	J. H. Nassir, “A Comparative Study between Dithranol and Other Topical Modalities in Treatment of Psoriasis,” Diploma Thesis, University of Baghdad, Baghdad, 1991.
[23]	M. H. Kanzler and D. C. Gorsulowsky, “Efficacy of Topical 5% Liquor Carbonis Detergens vs. Its Emollient Base in the Treatment of Psoriasis,” British Journal of Dermatology, Vol. 29, No. 3, 1993, pp. 310-314. http://dx.doi.org/10.1111/j.1365-2133.1993.tb11852.x
[24]	K. E. Sharquie, A. A. Noaimi and A. R. Auda, “Topical Therapy of Psoriasis by Using 5% and 10% Zinc Sulphate,” Thesis, Iraqi Board for Medical Specializations in Dermatology and Venereology, 2009.
[25]	G. D. Weinstein, “Tazarotene Gel: Efficacy and Safety in Plaque Psoriasis,” Journal of the American Academy of Dermatology, Vol. 37, 1997, pp. S33-S8.
[26]	G. G. Krueger, L. A. Drake and P. M. Elias, “The Safety and Efficacy of Tazarotene Gel, a Topical Acetylenic Retinoid, in the Treatment of Psoriasis,” Archives of Dermatology, Vol. 134, No. 1, 1998, pp. 57-60. http://dx.doi.org/10.1001/archderm.134.1.57