Background: Methotrexate (MTX) and cyclosporine have been used as effective systemic mono-therapy for psoriasis. Several factors are considered to switch monotherapy to combination therapy because monotherapy is no longer effective and has higher side effects. Hence,clinicians have avoided systemic therapy combinations due to its toxicity. However, some studies showed that this combination therapy could be usedeffectively for psoriasis patients. Purpose: This study aimed to analyze the efficacy and adverse effects of systemic MTX and cyclosporine combination therapy in Indonesian psoriasis vulgaris patients. Methods: The retrospective study assessed the effectiveness of 3 monthsmono-therapyand combination therapy of systemic MTX and cyclosporine in psoriasisvulgaris patients from 2016–2017 in Dermatology Clinic, Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia. Result: Psoriasis area and severity index (PASI) score 90 were achieved in the group MTX (50%) and cyclosporine group (50%), while none in the combination group.However, eight patients (50%) in group MTX and cyclosporine reached the primary endpoint of PASI 50. One patient in cyclosporine group had adverse effects on kidney profiles. Nonetheless, other patients had no biochemical changes. But, there was no significant difference in the change of PASI between each group (p=0.102). Conclusion: We propose that combination therapy of MTX and cyclosporine is relatively safe and efficacious in treating Indonesian psoriasis vulgaris patients. This combination treatment isas effective as MTX or cyclosporinemono-therapy.

AbstrakPsoriasis pustulosa generalisata (PPG) adalah bentuk khusus dari psoriasis yang bersifat akut dan berat. Etiologi yang belum diketahui secara pasti menyebabkan pengobatan PPG masih menjadi suatu tantangan. Terapi kombinasi dapat diberikan pada PPG yang berat maupun yang tidak memberikan respons terhadap terapi sistemik tunggal, selain itu terapi kombinasi juga dapat meningkatkan efektivitas dari obat tunggal. Dilaporkan satu kasus PPG pada seorang wanita yang diterapi dengan menggunakan kombinasi metotreksat (MTX) injeksi dan siklosporin. Dari anamnesis dan pemeriksaan fisis didapatkan pustula berkelompok pada dasar makula eritem yang bergabung membentuk lake of pus, disertai gejala sistemik demam dan leukositosis. Keluhan tersebut sudah berulang sejak 13 tahun yang lalu. Pasien diberikan terapi kombinasi injeksi MTX dan siklosporin. Pustula pada pasien menghilang setelah tujuh hari pemberian obat. Succesful Treatment of Generalized Pustular Psoriasis with a Combination of Methotrexate Injection and Cyclosporine AbstractGeneralized pustular psoriasis (GPP) is a special form of acute and severe psoriasis. The definite etiology of GPP remains a challenge. Combination therapy may be given to severe GPP or GPP that does not respond to a single systemic therapy sincecombination therapy may also improve the effectiveness of a monotherapy drug. A GPP case was reported in a woman treated with a combination of methotrexate (MTX) and cyclosporine. From anamnesis and physical examination it was revealed that there were clustered pustules on the base of erythematous macules that form a lake of pus accompanied by systemic symptoms of fever and leukocytosis. This was a recurrent complaint since 13 years ago. Patients were given combination therapy of MTX injection and cyclosporine. Pustules disappeared after seven days of drug administration. This case was the first combination therapy with MTX injection and cyclosporine used during the period of 19 May to 26 May 2017 at the Department of Dermatology and Venereology Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung, resulting in good results. [MKB. 2017;49(3):208-12]

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