Jawed H. AHMED, Saad Raheem ABD, Khalil I.Al-HAMDI

Effectiveness of oral zinc sulphate, oral methotrexate and their combination in the treatment of psoriasis

Amaç: Bu çalışmanın amacı, oral çinko sülfatın psoriazis tedavisinde tek başına ve metotreksat ile kombine edildiğinde etkinliğini araştırmaktır.Gereç ve yöntem: Toplam 60 psöriazis vulgaris’li hasta Ekim 2006 - Ekim 2007 tarihleri arasında çalışmaya alındı. Hastalar sistemik tedavilerine göre aşağıdaki gibi üç gruba ayrıldı: Grup 1 (20 hasta) oral çinko sülfat ile tedavi edilenler; Grup 2 (20 hasta) oral çinko sülfat+ oral metotreksat ile tedavi edilenler ve Grup 3 (20 hasta) tek başına oral metotreksat ile tedavi edilenler.Bulgular: Çalışmaya 34 (%56.7) erkek ve 26 kadın (%43.3) hasta (Erkek/Kadın oranı: 1.3/1) alındı. Oral çinko sülfat alan grupta hastaların yaklaşık %60’ında iyi sonuç alındı ve bu grupta tedavi kesilmesinden 4 hafta sonra hastaların %58’inde relaps gelişti. Oral çinko sülfat+Oral metotreksat kombinasyonu hastaların %85’inde iyi sonuç verdi ve tedavi kesilmesinden dört hafta sonra bu grupta %59 oranında relaps gözlendi. Tek başına metotreksat %70 hastada iyi sonuç verdi ve bu grupta tedavi kesilmesini takiben %64 hastada relaps gelişti. Oral çinko sülfat grubunda %30 hastada hafif yan etkiler gözlendiSonuç: Çinko sülfat psöriazis tedavisinde etkilidir, ancak çinko sülfat+Metotreksat kombinasyonu tek başına çinko sülfat veya metotreksat’tan daha etkili gözükmektedir.

Psöriazis tedavisinde oral çinko sülfat, oral metotreksat ve ikisinin kombinasyonunun etkinliği

Objectives: To evaluate the effectiveness of oral zinc sulphate in treatment of psoriasis alone or in combination with methotrexate. Materials and methods: A Total of 60 patients with psoriasis vulgaris were recruited for the study during the period October 2006 to October 2007. The patients were divided in to three groups according to their systemic treatments, as follows: Patients in Group1 (20 patients) were treated with oral zinc sulphate, Group 2 (20 patients) were treated with zinc sulphate plus oral methotrexate and patients in Group 3 (20 patients) were treated with oral methotrexate alone. Results: There were 34 (56.7%) men and 26 (43.3%) women, with a male: female ratio 1.3:1.Their age ranged from 15-70 years with a mean of 32±11 years. Oral zinc sulphate produced a good response in about 60% of the cases; with a relapse rate amounts to 58% noticed 4 weeks after cessation of treatment. Combination of oral zinc sulphate and methotrexate induced a good response in 85% of the patients, with a relapse rate of 59 % that was noticed 4 weeks after treatment cessation. Methotrexate alone induced a good response in 70% of the patients with a relapse rate of 64%. Mild adverse effects were reported in 30% of the cases on zinc sulphate treatment.Conclusion: Zinc sulphate is an effective treatment of psoriasis but the combination of zinc sulphate plus methotrexate could be more effective than zinc sulphate or methotrexate alone.

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1. Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet 2007;370:263-71.
2. Bruner CR, Feldman SR, Ventrapragada M, Fleischer AB. A systematic review of adverse effects associated with topical treatments for psoriasis. Dermatol Online J 2003;9:2-11.
3. British Association of Dermatologists. Guidelines for management of patients with psoriasis. Workshop of the Research Unit of the Royal College of Physicians of London; Department of Dermatology, University of Glasgow. BMJ 1991; 303:829–35.
4. Reich K, Nestle FO, Papp K, Ortonne JP, Evans R, Guzzo C, Li S, Dooley LT, Griffiths CE. Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: a phase III, multicentre, double-blind trial. Lancet 2005; 366:1367-74.
5. Clemmensen OJ, Siggaard-Andersen J, Worm AM, Stahl D, Frost F, Bloch I. Psoriatic arthritis treated with oral zinc sulphate. Br J Dermatol 1980; 103:411-5.
6. Verma KC, Saini AS, Dhamija SK. Oral zinc sulphate therapy in acne vulgaris: a double-blind trial. Acta Derm Venereol1980; 60:337-40.
7. Ewing CI, Gibbs AC, Ashcroft C, David TJ. Failure of oral zinc supplementation in atopic eczema. Eur J Clin Nutr. 1991; 45:507-10.
8. Burrows NP, Turnbull AJ Punchard NA, Thompson RP, Jones RR. A trial of oral zinc supplementation in psoriasis. Cutis 1994;54:117-8.
9. Reich K, Mrowietz U: Treatment goals in psoriasis. J Dtsch Dermatol Ges 2007;5:566–74.
10. Gisondi P, Fantuzzi F, Malerba M, Girolomoni G. Folic acid in general medicine and dermatology. J Dermatolog Treat. 2007;18:138-46.
11. Direct colorimetric determination of zinc. Cat number 0033 kit size:2× 5ml, Roma-Italy-via Cervinara- email:giesseonline@tiscalinet.
12. Dave’s M. The Psoriasis Area and Severity Index: Internet 2003. http://www. Dave’s Psoriasis Info.com.
13. Rea JN, Newhouse ML, Halil T. Skin disease in Lambeth. A community study of prevalence and use of medical care. Br J Prev Soc Med 1976; 30:107-14.
14. Kormeili T, Lowe NJ, Yamauchi PS. Psoriasis: Immunopathogenesis and Evolving immunomodulators and systemic therapies; U.S. experiences. Br J Dermatol 2004;151:3-15.
15. Sharquie KE, Najim RA, Farjou IB, AL- Timimi DJ. Oral zinc sulphate in the treatment of acute cutaneous leishmaniasis. Clin Exp Dermatol 2001; 26:21-6.
16. Al-Gurairi FT, Al-Waiz M, Sharquie KE. Oral zinc sulphate in the treatment of recalcitrant viral warts: randomized placebo controlled clinical trial. Br J Dermatol 2002;146:423-31.
17. AL-Dori WS. Oral zinc sulphate in the treatment of Behcet’s disease; a double blind-cross over study. A thesis submitted to the Iraqi Board for Medical Specialization, Dermatology and Venereology 2004.
18. Sharquie KE, Najim RA, Al-salman HN. Oral zinc sulfate in the treatment of rosacea : a double-blind, placebo– controlled study. Int J Dermatol 2006;45:857-61.
19. Mahajan PM, Jadhav VH, Patki AH, Jogaikar DG, Mehta JM. Oral zinc therapy in recurrent erythema nodosum leprosum: a clinical study. Indian J Lepr 1994; 66:51-7.
20. Lutz G, Kreysel HW. Selective changes in lymphocytic differentiation antigens in the peripheral blood of patients with alopecia areata treated with oral zinc. Z Hautkr 1990;65:132-4.
21. McMillan EM, Rowe D. Plasma zinc in psoriasis: Relation to surface area involvement. Br J Dermatol 1983;108:301-5.
22. AL-Timimi DJ, Al-Shama G, Al-Shaarbaf H. Serum zinc, copper, and magnesium in patients with chronic renal failure and dialysis. J Fac Med Baghdad 1988;30:259-64.
23. Nigam PK. Serum zinc and copper levels and Cu: Zn ratio in psoriasis. Indian J Dermatol Venereol Leprol 2005;71:205-6.
24. Al-Timimi DJ, Al-Sharbatti SS & Al-Najjar F. Zinc deficiency among a healthy population in Baghdad, Iraq. Saudi Med J 2005;26:1777-81.
25. Prasad AS. Clinical and biochemical manifestation of zinc deficiency in human subjects. J Pharmacol 1985; 16:344-52.
26. Malatjalian DA, Ross JB, Williams CN, Colwell SJ, Eastwood BJ. Methotrexate hepatotoxicity in psoriatics: Report of 104 patients from Nova Scotia, with analysis of risks from obesity, diabetes and alcohol consumption during long term follow-up. Can J Gastroenterol 1996;10:369-75.
27. Dardenne M. Zinc and immune function. Eur J Clin Nutr. 2002;56:S20- 3.
28. Rhodes D, Klug A. Zinc fingers. Sci Am 1993; 268:56-9.
29. Rostan FF, DeBuys HV, Madey DL, Pinnell SR. Evidence supporting zinc as an important antioxidant for skin. Int J Dermatol 2002;41:606-11.
30. Löntz W, Sirsjö A, Liu W, Lindberg M, Rollman O, Törmä H. Increased mRNA expression of manganese superoxide dismutase in psoriatic skin lesions and in cultured human keratinocytes exposed to 1L-1 beta and TNF- alpha. Free Radic Biol Med 1995;18: 349-55.