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

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

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