Comparison between the effects of Daivonex cream alone and its combination with narrowband ultraviolet B in treatment of psoriasis

285 How to cite this article: Babaei Nejad S, Herizchi Ghadim H, Ezzati A, Nobahari S, Emami Khatib E, Masoudnia S. Comparison between the effects of Daivonex cream alone and its combination with narrowband ultraviolet B in treatment of psoriasis. Our Dermatol Online. 2015;6(3):285-288. Submission: 14.01.2015; Acceptance: 27.06.2015 DOI: 10.7241/ourd.20153.76 Comparison between the effects of Daivonex cream alone and its combination with narrowband ultraviolet B in treatment of psoriasis

study cases totally random.To determine the sample size we used Rim Jh and colleagues study.In this study, the changes in the intensity of the thickness (induration) was considered as the primary outcome 94 individuals.
During the process of collecting samples from individuals who have less than 10% BSA or had limited psoriasis, if other criteria were matched they referred to responsible resident to be reviewed.The patients were randomly divided into 2 groups of 47, with no age limit.Anthropometric characteristics such as height and weight were determined for each individual.Duration of illness in patients was determined and patients were categorized according to the type of medication or unit weight in mg doses and duration of drug use.And each group was been treated with one of the 2 therapy methods as follows: All the patients underwent routine tests before starting treatment.Those in the treatment group of Daivonex.Cream used 5.0 mg every 12 hours to the surface of the body used the palm of a hand to measure it.Patients used creams with Behestan Behdasht (under license Leo pharma, Denmark) brand.Those in the treatment group witch treated with cream Daivonex with NBUVB 2 times a week using Dermapal 800 Davlin machine made in United States of America with a primary energy of 2.0 joules per square centimeter were under phototherapy.In the next sessions 1/0 joules per square centimeter on the amount of energy was added by the system.These patients were similar to the previous group witch were using cream with the difference that in the days of phototherapy, the cream used after PHOTOTHERAPY.All patients at baseline and 4, 8 and 12 weeks after starting treatment were visited and the improvement of erythema, scaling, thickening (induration) lesion (no = 0, less than 30% = low, 30 -60% = average, over 60% = high) and the response to treatment was assessed and defined in to grades according to the following Table 1.
For 12 weeks, according to previous studies, it was enough for patients and patients relapse after completion of the study were not examined.
To eliminate bias in the study some inclusion criteria were determined.
Inclusion criteria for this study include:
The duration of the disease, patients in group A, with an average 4.16±4.45years and group B with an average of 5.37±7.82years.Statistically significant differences  between the groups in duration of disease was observed (P=0.387).
Among the most affected areas of the body, legs.Statistically no significant differences showed in the place of the lesions between the two groups (P=0.594).
Due to the significant chi-square value of P=0.842, there is no significant difference in the extent of lesions between the two groups.
According to the results presented by sex, age, weight, height, history of diabetes, duration of psoriasis, the involvement of problem and size difference between the two groups A and B was not significant.In comparing the recovery of patients in groups A and B, of erythema, scaling and thickness investment (induration) at weeks 4, 8 and 12, the following information was obtained: About Improving in the levels of erythema 4 grades including, no erythema = 4, (low) less than 30% = 3, (average) 30-60% = 2 and (much) more than 60% = 1, coded and measured.
All patients in both groups at baseline were with high erythema (60%).The mean improvement in erythema at different is described weeks in Table 2.
All patients in both groups at baseline had more scaling investment.The mean improvement in the scaling investment (Table 2) is visible.In group B recovery were greater and faster than in group A.
In All patients of both groups at baseline lesions were too thick.Average improvement in thickness described in Table 1.Five levels in recovery including: no recovery = 0, low recovery in scaling or erythema less than 20% = 1, average recovery with smooth scaling and erythema (20-50%) = 2, nice smooth complete recovery with a palpable edge of the crust and no erythema (50-95%) = 3 and full recovery (over 95%) = 4 is defined and measured.
Improvement Process at week 4 in Group A was 1.19± 0.76 and in group B was 1.76±0.93.Due to the significant level of p=0.002 in the recovery of group A and B at 4 weeks of treatment, there was a statistically significant difference.
In group A, the mean recovery in week 8 was 1.86±1.06and in group B was 2.71± 0.94.Due to the significant level of P=0.000 in the recovery of group A and B at 8 weeks of treatment, there was a statistically significant difference.
In group A, the mean recovery in week 12 was 2.56±1.18and in the group B was 0.86 ± 3.55.Due to the significant level of P=0.000 in the recovery of group A and B at 12 weeks of treatment, there was a statistically significant difference.
In both groups recovery was observed but in group B recovery was more and faster than in group A. So that at the end of the study the group witch used cream Daivonex had 30.2% of complete recovery but patients in group B witch treated by phototherapy with narrowband ultra violet and Daivonex cream in the combination 73.8% of complete recovery was observed.

DISCUSSION
According to the results of our study subjects in the two groups in terms of sex, age, weight, height, history of diabetes, duration of psoriasis, the plight and size differences were not significant The mean improvement in erythema and crust investment and improve in lesion thickness overall recovery of lesion in the fourth week, eighth and twelfth after starting treatment in patients who were treated with creams and phototherapy were Significantly higher than the group that used the cream alone.The results of our study show that the use of cream in combination with phototherapy Daivonex Phototherapy with faster and more recovery at a time can be used to provide better results [8].It can be concluded that patients can improve the speed of treatment side effects, including cumulative effects of phototherapy dose reduction That the matter should be further investigated in other comparative studies.Similar to Noborio et al study in 2006 concluded that the therapeutic effects of Calcipotriol is higher than other drugs in combination with phototherapy [9].The results of our study showed that Calcipotriol in combination with phototherapy increase the speed and the amount of improvement.
As a study done by Jong-Hyun Rim et al [10] in our study, the use of Calcipotriol cream in combination with phototherapy with an appropriate treatment was introduced to accelerate and enhance recovery.
As a study done by Takahashi et al [6], the results of our study showed that the combination of Calcipotriol Ointment with NB-UVB twice a week, compared to other treatments, the rate and extent of psoriasis of lesion can be further improved.
As a study done by Rogalski et al [7] as well as a study done by Roussaki-Schulze et al [11], in our study group Calcipotriol alone received less improvement than the other groups showed.This could indicate an increased therapeutic effect in combination with other treatments is Calcipotriol, or excimer laser, or narrowband ultraviolet radiation.
Unlike our study Karakawa et al as "the period of remission treated with narrowband ultraviolet B in psoriasis vulgaris" did And retrospectively studied the factors that influence the duration of remission after photo chemotherapy so we compared [8].The two methods together, to achieve a therapeutic effect that is the most efficient and lowest paid.

CONCLUSION
The results of our study show that the use of cream Daivonex in combination with phototherapy By creating more and faster recovery time can be as a treatment that can be used to provide better results So that in the group treated with cream Daivonex, at the end of the study 30.2% of patients achieved complete remission, while the combination of cream and ultra violet Daivonex narrowband cure rate was 73.8 percent.

Statement of Human and Animal Rights
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Statement of Informed Consent
Informed consent was obtained from all patients for being included in the study.

Table 1 :
Grades evaluation of treatment

Table 2 :
Frequency of results of two group treatment Group A: group under treatment of Daivonex only, Group B: Group under treatment of Daivonex with NBUVB