Comparative Analysis of Treatment Efficacy in Psoriasis Using Topical Versus Systemic Therapies

Thesis Abstract

Psoriasis is a chronic inflammatory skin disorder characterized by significant morbidity and impact on quality of life, yet the comparative efficacy of topical versus systemic therapies remains inadequately elucidated, especially in diverse clinical settings. This study aims to empirically evaluate and compare the clinical outcomes of topical and systemic treatments in psoriasis management, thereby contributing to optimized therapeutic strategies tailored to patient needs. The specific objectives include assessing treatment response rates, evaluating adverse effect profiles, examining patient adherence levels, and identifying predictors of treatment success across both therapeutic modalities. Employing a cross-sectional comparative design, the study was conducted at dermatology clinics within a tertiary hospital setting. The target population comprised adult patients aged 18–65 diagnosed with moderate to severe plaque psoriasis, with a total population of approximately 200 eligible patients identified through clinical records over a 12-month period. A stratified random sampling technique was used to select a sample size of 100 patients, evenly divided into two groups those receiving topical therapies (e.g., corticosteroids, vitamin D analogs) and those on systemic treatments (e.g., methotrexate, biologics). Inclusion criteria mandated a minimum ongoing treatment duration of three months and documented clinical assessment records. Data collection instruments consisted of structured patient interviews, standardized clinical assessment forms including the Psoriasis Area and Severity Index (PASI), and adherence questionnaires validated for dermatological use. To ensure data validity and reliability, pilot testing was conducted with a subset of 10 patients, and Cronbach’s alpha coefficients for adherence scales exceeded 0.80. Quantitative data were analyzed using descriptive statistics, chi-square tests for categorical variables, and independent samples t-tests to compare treatment response scores. Multivariate regression analyses were conducted to identify predictors of treatment efficacy, controlling for confounding variables such as age, disease duration, and comorbidities. The analytical framework was grounded in the Health Belief Model, which explains patient adherence and treatment outcomes based on individual perceptions and beliefs about illness and therapy. Expected findings include statistically significant differences in PASI score reductions favoring systemic therapies in cases of severe psoriasis, alongside comparable response rates in moderate cases. Adverse effects are anticipated to be more prevalent in the systemic therapy group, whereas adherence patterns might favor topical treatments due to fewer perceived risks. The study also expects to identify key demographic and clinical predictors influencing treatment success, such as disease severity at baseline and patient education level. This research contributes to dermatological practice by providing evidence-based comparisons of treatment modalities, highlighting the advantages and limitations inherent to each approach, and identifying factors influencing treatment outcomes. It advances existing literature by integrating clinical efficacy, patient adherence, and adverse effect profiles within a comprehensive analytical model, addressing previous gaps related to contextual and demographic variability. The main conclusion underscores the importance of individualized treatment planning, considering disease severity, patient preferences, and potential risks, with recommendations for clinicians to adopt a stratified approach to psoriasis management. The study advocates for further longitudinal research to substantiate causal relationships and explore long-term treatment sustainability. Additionally, policy implications suggest enhancing patient education and adherence support mechanisms, particularly for systemic therapies, to optimize clinical outcomes and minimize adverse effects.