Methotrexate Plus NB-UVB for Treatment of Palmoplantar Psoriasis

Patients with palmoplantar psoriasis achieved a better clinical response, including a greater reduction in the number of lesions on the palms and soles of the feet, with methotrexate plus narrowband ultraviolet light B (NB-UVB) phototherapy compared with methotrexate alone, according to study findings published in Dermatologic Therapy.

This single-center comparative trial randomly assigned 90 patients with moderate to severe recalcitrant palmoplantar psoriasis to either weekly oral 10 mg methotrexate monotherapy (n=45) or weekly oral 10 mg methotrexate plus twice-weekly NB-UVB (n=45). Both researchers and patients were unblinded to their assigned therapy, and the treatment period ran for 12 weeks.

The investigators used the modified Palmoplantar Psoriasis Area Severity Index (m-PPPASI) to assess lesions on the palms and soles at baseline and every 2 weeks. Lesions were assessed through photographs at baseline and at the end of weeks 4, 8, and 12. A reduction in the m-PPPASI score at week 12 comprised the primary outcome.

There was no difference in the monotherapy and combination groups in terms of age at baseline (38.1±9.9 vs 40.1±11.0 years, respectively; P =.380). Patients randomly assigned to methotrexate plus NB-UVB had a significantly greater reduction in their mean m-PPPASI score from baseline to week 12 compared with the methotrexate monotherapy group (mean reduction by 12.19±.65 vs 10.39±2.49 points, respectively; P =.001).

At week 12, the mean m-PPPASI was 3.66±2.11 with methotrexate plus NB-UVB vs 6.51±2.04 with methotrexate only (P <.001). A total of 20 (44.44%) patients in the combination therapy arm achieved marked improvement (m-PPPASI 75) compared with only 6 (13.3%) patients in the monotherapy arm (P <.001). A greater proportion of patients randomly assigned to methotrexate plus NB-UVB experiencedadverse events, including irritation, erythema, pruritus, pain, and scaling (P <.001 for all).

Limitations of the study included its small number of patients, the single-center and open-label design, and the limited follow-up period.

Based on these findings, the researchers wrote that the “combined therapy could be recommended as first-line systemic therapy of palmoplantar psoriasis, especially in countries with constrained financing of medical care.”


Ara S, Mowla MR, Alam M, Khan I. Efficacy of oral methotrexate (MTX) monotherapy vs oral MTX plus narrowband ultraviolet light B phototherapy in palmoplantar psoriasis [published online May 1, 2020]. Dermatol Ther. doi: 10.1111/dth.13486