Comparison of efficacy, safety, and cost-effectiveness of topical salicylic acid 6% versus clobetasol propionate 0.05% in the treatment of limited chronic plaque psoriasis

Aims: The aims of this study were to: (1) Comparison of Psoriasis Area Severity Index (PASI), Physician Global Assessment (PGA) Scores, and adverse effect profile on the use of topical salicylic acid 6% versus clobetasol propionate 0.05% in the chronic-limited plaque psoriasis.(2) Selection of the cost-effectiveness option using average cost-effective ratios of the two individual regimens. Materials and Methods: This was a randomized, open-labeled, parallel group design which was conducted at dermatology department of a tertiary care hospital located in resource-limited settings of South India. A total of 75 patients were recruited and randomized into two groups: Group A received 6% of topical salicylic acid and Group B received 0.05% of clobetasol propionate for 3 months with a three follow-up visits. Efficacy was assessed based on the reduction of PASI and PGA scores at each visit. The safety profile of two drugs was assessed by a screening of adverse drug reactions. Cost-effectiveness of treatment groups was calculated by considering inputs of direct medical costs required to reduce one unit on PGA scale. Results: Demographic and clinical profiles of participants were matched between two groups. The mean PASI score of Group A and Group B were reduced from baseline (4.36, 4.67) to final follow-up (1.97, 2.03). There was a statistically significant difference exist in mean PASI score difference of Group A and Group B from baseline to 1st follow-up and baseline to 2nd follow-up (P < 0.00001) visits. Whereas, at final follow-up, mean PASI score difference of two groups was almost equal (P < 0.21). Conclusion: Initially, clobetasol propionate shows more effective compared to salicylic acid in the reduction of PASI score. But at end of the treatment, both drugs were equal in the reduction of PASI score where only matters the cost. Salicylic acid was a cost-effectiveness option in limited chronic plaque psoriasis.