Dermoscopic Prediction of Therapeutic Response in Psoriatic Lesions Treated with Methotrexate and Apremilast: An Observational Study on Skin Color

Psoriasis is a chronic auto-inflammatory condition. Treatment modalities include methotrexate (MTX) and apremilast (APL). Although the efficacy of MTX and APL is well studied, evidence of their superiority of one over the other is lacking. Dermoscopy is helpful in diagnosis and treatment evaluation. Therefore, dermoscopy is utilized to assess the treatment response.

This study aimed to evaluate dermoscopic assessment in psoriatic lesions treated by MTX and APL and compare their efficacy by calculating the respective Psoriasis Area and Severity Index (PASI) scores and study the effect of MTX and APL on different dermoscopic patterns in psoriasis at different levels of treatment.

This randomized interventional comparative study was conducted in a tertiary care hospital. A total of 98 patients were randomly divided into two groups of 50 and 48 patients, given oral/intramuscular MTX 7.5 mg once weekly and APL 30 mg twice daily for 3 months, respectively. The patients were assessed clinically and dermoscopically using a videodermoscope, and comparisons were performed between the two groups. The PASI score was calculated and evaluated.

The PASI score was reduced by 83% and 65% from the baseline in MTX and APL groups, respectively. The patients with patchy (61.5%) and minimal (23%) patterns of vessels and red dots (92.3%) showed faster achievement of PASI-100. However, the patients with a regular distribution of vessels and globular vessels failed to obtain PASI-100, suggesting a poor response to treatment.

Vascular structures play a significant role in the diagnosis and prediction of the treatment response. Particular patterns and type vessels under dermoscopy can give a hint about choosing appropriate drugs for psoriasis.