Hydroxyurea in the management of therapy resistant psoriasis

Abstract

Eighty-five patients with extensive chronic plaque psoriasis, unresponsive to conventional topical therapy, were treated with long-term hydroxyurea in a dose of 0.5-1.5 g daily. Fifty-two (61%) had a satisfactory remission during treatment without significant adverse effects. Treatment was discontinued in 33 patients (39%), due to an inadequate response or significant relapse during treatment and because of adverse reactions (19%). Four (4.7%) patients on hydroxyurea developed actinic psoriasis. Significant haematological abnormalities occurred in 30 patients (35%), but these became normal following a reduction in the dose of hydroxyurea or temporarily stopping the drug. In only six was it considered necessary to discontinue treatment because of bone marrow suppression. Our experience suggests that hydroxyurea is an effective long-term treatment for psoriasis that is refractory to conventional topical therapy and that the incidence of serious adverse effects compares favourably with other cytotoxic drugs.

Methotrexate versus hydroxycarbamide (hydroxyurea) as a weekly dose to treat moderate‐to‐severe chronic plaque psoriasis: A comparative study

“…It was reported to be effective in refractory psoriasis for the first time by Yarbo in 1969 (15). Since then many reports have shown favorable but variable results (6,8,9,(15)(16)(17)(18)(19). However, it is probably difficult to evaluate the efficacy of hydroxycarbamide from these studies as various workers have used different doses for varying periods of time and evaluated their patients by different criteria.…”

Guidelines of care for the management of psoriasis and psoriatic arthritis

“…In all, 60% of patients achieved complete to near complete clearing. 159 In another nonrandomized study of 31 patients with recalcitrant psoriasis, 75% of patients treated with 1 to 1.5 g/d of hydroxyurea showed at least a 35% reduction in the PASI score and 55% had more than a 70% reduction in the PASI score. 160 A comparative study of methotrexate and hydroxyurea was recently undertaken in 30 patients.…”

“…In a retrospective study, 85 patients received hydroxyurea with no placebo or active control group for a mean duration of 16 months. 159 Although dosing varied according to response, most patients were treated with dosages of 0.5 to 1.5 g/d. In all, 60% of patients achieved complete to near complete clearing.…”

Therapeutic progress II: treatment of psoriasis

“…Hydroxyurea 500 mg twice daily can also be effective, and its use may be considered in the treatment of patients who cannot receive methotrexate because of cirrhosis or other limiting factors (37). Treatment with hydroxyurea must be monitored with great care because the therapeutic dose is very close to that which causes marrow suppression, but this is quickly reversible on stopping the drug.…”