Rediscovering hydroxyurea: its role in recalcitrant psoriasis

Background There is an acute paucity of second-line systemic agents for the treatment of extensive chronic plaque psoriasis (CPP). Recent studies usin g hydroxyurea in patients with HIV infection and sickle cell anemia have re kindled interest in this old drug and have provided more data regarding saf ety and dosage. Objective We wanted to test the efficacy and tolerability of hydroxyurea in patients with extensive CPP who had to discontinue first-line oral agents for any reason. Methods The study was a prospective nonrandomized series. Thirty-one patien ts, including 26 with prior history of systemic antipsoriatic therapy were given hydroxyurea 1-1.5 g per day for a median duration of 36 weeks. They w ere followed up for a mean period of 36.1 +/- 13.8weeks. Results Almost 75% of the patients showed an adequate response (35% reducti on in Psoriasis Area and Severity Index at or before 8 weeks) with over hal f showing more than 70% reduction in PASI score. All adverse effects were m ild and reversible and none of the patients required cessation of therapy. Conclusion Hydroxyurea is an effective, very safe but relatively slower act ing alternative for patients with extensive CPP over the short-to-medium te rm.