Comparative Study on the Clinical Efficacy and Safety of Acitretin and MTX in the Treatment of Pustular Psoriasis by TLR7/MyD88/CXCL16 Pathway

OBJECTIVE: To investigate the clinical efficacy and safety of acitretin and MTX with TLR7/MyD88/CXCL16 in the treatment of pustular psoriasis. METHOD: A total of 54 patients with pustular psoriasis were randomly divided into control group (n = 14) and study group (n = 40). MTX was used in the control group, and different doses of acitretin were used in the study group, which were divided into low-dose group (n = 13), medium-dose group (n = 13), and high-dose group (n = 14). Symptom relief time, recurrence rate, GPPASI improvement rate, treatment response rate, BSA, DLQI score, and TLR7 and CXCL16 levels were compared among four groups. RESULT: The erythema, fever, and pustules disappeared in the low-dose group, the medium-dose group, and the high-dose group for a shorter time than control group, and it is shortest for the high-dose group. The low-dose, medium-dose, and high-dose groups had relatively lower recurrence rates at 1 month and 3 months (P < 0.05). The improvement rates of GPPASI50 of the four groups (the control group, low-dose group, medium-dose group, and high-dose group in turn) were 71.4%, 78.3%, 80.2%, and 80.8%; GPPASI75 of the four groups were 73.5%, 74.3%, 79.4%, and 80.9%; and GPPASI90 were 12.9%, 13.1%, 13.4%, and 13.8%. After treatment, the BSA and DLQI scores of the four groups were reduced. The BSA and DLQI scores of the study group decreased more significantly, and the high-dose group had the most significant improvement (P < 0.05). The incidence of adverse reactions in the four groups was 16.2%, 8.1%, 10.3%, and 14.7%, respectively. The high-dose group had a higher incidence of adverse reaction than the low-dose group (P < 0.05). The effective rates of treatment of the four groups were 69.1%, 86.9%, 88.2%, and 91.9%, respectively. The study group had higher treatment efficiency than the control group, and the high-dose group had the highest treatment efficiency (P < 0.05). After treatment, the level of serum TLR7 and CXCL16 was significantly reduced, but which in the study group decreased more significantly (P < 0.05). CONCLUSION: The clinical effect of a high dose of acitretin on pustular psoriasis is remarkable. It can reduce the recurrence rate and improve the quality of life and clinical symptoms. Therefore, a high dose of acitretin is worth popularizing and applying.