Goeckerman therapy versus methotrexate for psoriasis: a study on military personnel

Year 2022, , 297 - 300, 17.01.2022

Aslan Yürekli , Mustafa Tunca Kadir Küçük , Ayşenur Botsali , Ercan Çalışkan

https://doi.org/10.32322/jhsm.987347

Abstract

Introduction: Although methotrexate is a widely used systemic medication for psoriasis, a restrictive cumulative dosage limits its use in each patient, and a liver biopsy is recommended when the cumulative dose reaches 3.5–4.0 mg. As an alternative, Goeckerman therapy is a safe, efficient, tar-based method of treating psoriasis but one used increasingly less in recent decades due to the inconvenience of tar application and of requiring outpatients to remain covered in tar before receiving phototherapy hours if not a day later. However, for patients such as soldiers who can be treated as inpatients, Goeckerman therapy is preferable due to its efficacy and good safety profile.
Material and Method: We retrospectively evaluated 96 patients with psoriasis, all military personnel, who had been treated with either methotrexate (n=49) or Goeckerman therapy (n=47) between 2012 and 2016. Their baseline and exit Psoriasis Area and Severity Index (PASI) scores were comparatively analyzed.
Results: No statistical difference in relative recovery emerged between patients who had received methotrexate and ones who had undergone Goeckerman therapy. Both groups had achieved a mean PASI score of 75 at approximately the same time.
Conclusion: When the rapid return to work is important, we recommend using Goeckerman therapy to treat psoriasis given its relatively low side effect profile and lack of immunosuppressive action. Both advantages can benefit patients such as soldiers who are able to undergo treatment in inpatient settings, cannot meet physicians frequently due to work requirements, and cannot avoid the risk of infection (i.e., a risk factor for methotrexate use) due to living in crowded spaces.

Keywords

goeckerman, methotrexate, psoriasis vulgaris, coal tar, phototherapy

Project Number

yok

References

• Michalek IM, Loring B, John SM. A systematic review of worldwide epidemiology of psoriasis. J Eur Acad Dermatol Venereol 2017; 31: 205–12.
• Ferreira BI, Abreu JL, Reis JP, et al. Psoriasis and associated psychiatric disorders: a systematic review on etiopathogenesis and clinical correlation. J Clin Aesthet Dermatol 2016; 9: 36–43.
• Kelly JB, Foley P, Strober B. Current and future oral systemic therapies for psoriasis. Dermatol Clin 2015; 33: 91–109.
• Diani M, Grasso V, Altomare G. Methotrexate: practical use in dermatology. G Ital Dermatol Venereol 2016; 151: 535–43.
• Haustein UF, Rytter M. Methotrexate in psoriasis: 26 years’ experience with low-dose long-term treatment. J Eur Acad Dermatol Venereol 2000; 14: 382–8.
• Strober BE, Siu K, Menon K. Conventional systemic agents for psoriasis: a systematic review. J Rheumatol 2006; 33: 1442–6.
• Gupta R, Debbaneh M, Butler D, et al. The Goeckerman regimen for the treatment of moderate to severe psoriasis. J Vis Exp 2013; 77: Article 50509.
• Lee E, Koo J. Modern modified “ultra” Goeckerman therapy: a PASI assessment of a very effective therapy for psoriasis resistant to both prebiologic and biologic therapies. Journal of Dermatological Treatment 2005;16: 102–7.
• Çalıskan E, Tunca M, Açıkgöz G, et al. Narrow band ultraviolet-B versus Goeckerman therapy for psoriasis with and without acitretin: a retrospective study. Indian J Dermatol Venereol Leprol 2015; 81: 584–7.
• Zhu TH, Nakamura M, Farahnik B, et al. The Patient’s Guide to Psoriasis Treatment. Part 4: Goeckerman therapy. Dermatol Ther (Heidelb) 2016; 6: 333–9.
• Stern RS, Zierler S, Parrish JA. Skin carcinoma in patients with psoriasis treated with topical tar and artificial ultraviolet radiation. Lancet 1980; 2: 732–3.
• Studniberg HM, Weller P. PUVA, UVB, psoriasis, and non-melanoma skin cancer. J Am Acad Dermatol 1993; 29: 1013–22.
• Hearn RM, Kerr AC, Rahim KF, et al. Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy. Br J Dermatol 2008; 159: 931–5.
• Şentürk N. Methotrexate. Turkderm-Arch Turk Dermatol Venerology 2016; 50: 18–21.
• Hugh JM, Weinberg JM. Update on the pathophysiology of psoriasis. Cutis 2018; 102: 6-12.
• Korman NJ. Management of psoriasis as a systemic disease: what is the evidence? Br J Dermatol 2020; 182: 840-8.
• Schleicher SM. Psoriasis: Pathogenesis, Assessment, and Therapeutic Update. Clin Podiatr Med Surg 2016; 33: 355-66.
• Alwan W, Nestle FO. Pathogenesis and treatment of psoriasis: exploiting pathophysiological pathways for precision medicine. Clin Exp Rheumatol 2015; 33: 2-6.
• Griffiths CEM, Armstrong AW, Gudjonsson JE, Barker JNWN. Psoriasis. Lancet 2021; 397: 1301-15.
• Staubach P, Zimmer S. Plaque psoriasis - more than a skin disorder. Med Monatsschr Pharm 2017; 40: 231-3.