Vp1.5, No. 2. - SINGAPORE MEDICAL JOURNAL 6g June, 1964. CLINICAL TRIAL OF P-1742 TOPICAL OR FLUPEROLONE (9 IPLUORO-21 METHYL PREDNISOLONE) IN PSORIASIS By Khoo Oon Teik, Fung Wye Poh (Skin Clinic, Dept. of Clinical Medicine, University of Singapore). and Koh Kim Yam (Middle Road Hospital, Singapore).

The use of triamcinolone in Psoriasis is now OBJECTS OF THE TRIAL WERE well established (Cohen and Baer 1960; Readett 1. to determine the effectiveness of P-1742 1961). However topical triamcinolone therapy topical as against has only lately come into prominence and the triamcinolone Aceto- nide cream. employment of triamcinolone cream with occlusion of the area from air by a non -porous 2. to compare the regime as against pre- covering was shown to be of even greater vious therapy. benefit by Frank and Rapp, 1963. 3. to evaluate the effectiveness of an occlusive agent. Recently, Chas Pfizer & Co. has announced preliminary trials with a new corticosteroid RESULTS: preparation, P-1742 or fluperolone (9 -fluoro -21 Table lists the cases treated methyl Prednisolone) in the treatment of der- l:- The cases were graded thus: - matoses. The results suggested superiority over ISQ = no change in the lesions triamcinolone cream. In view of the decided action of triamcinolone acetonide in Psoriasis, O = worse, when lesions became it was decided to evaluate the action of topical redder, more scaly and thicker. fluperolone in psoriasis, and to compare its' F + = marked improvement, when action with triamcinolone acetonide cream. lesions almost cleared up com- pletely. METHOD ++ = fair or moderate improvement The cases chosen for the trial were either as shown by less erythema, those cases previously treated with other agents scaling, and thickness. or new cases without previous therapy. One f = slight improvement. qualification was considered necessary i.e. the lesions whether discrete, discoid, guttate, or Table 11.: shows comparison between treat- generalised, must be bilateral and symmetrical ment with fluperolone, triamcinolone acetonide, and approximately of the same area involved. and the old treatment with topical tar ointment and ultra-violet irradiation. (The ointment Throughout the trial the right half of the contained liquor picis carbonis 6, salicylic acid body or the right limb or the right half of the 4, Ung H.A.D. to 100). face was treated with P-1742 topical, while the other half with a standard triamcinolone Side effects no side effects were noticed. Acetonide preparation (Kenacort A -Squibb). Discussion: In a chronic illness such as The cream was applied twice - a day for 10 days psoriasis any shortening of the period of treat- or 2 weeks, when the case was inspected and ment is a definite gain. In Singapore, where the progress by checked the same investigator the weather is always humid and hot the and photographed again. If little or no im- greater part of the year, it was generally felt provement was noted, the area treated was that any occlusive type of therapy would be occluded from air with polythene material very uncomfortable, and not tolerated by the the edges being fixed by Norbocutane Spray patients. However only 2 cases out of 11 cases (Evans) or Scotch tape, the part having been were unable to take this occlusive form of treated with the cream first. treatment and in these 2 cases the lesions RESULTS WITHOUT OCCLUSION RESULTS WITH OCCLUSION CASE TYPE OF RACE SEX AGE ODURATIONF DISEASE No. (in years) LESIONS on years) RIGHTSIDE(F) LEFT SIDE(T) RIGHT SIDE(F) LEFT SIDE(T) LINEAR 1 CH F 19 PLAQUE I +++ +++

ISQ I S Q 2 CH M 42 DISCRETE 7 + +

3 IND F 18 GUTTATE 2 + + + ++ CIRCINATE 4 CH M 19 AND DISCOID 2 ++ +

DISCOID -1-1- 5 IND M 44 AND GUTTATE I + + + MULTIPLE G CH M 48 D 2 + + + +-1- MULTIPLE 7 CH F 26 6 0 0 0 0 DIFFUSE 0 8 CH F 42 PLAQUES 2 0 0 0

MULTIPLE B 9 CH M 43 DISCOID + + + + + 0 + 10 CH F 55 ANDADISCOID 15 0 PATCHY 11 IND M 27 AND OVOID 7 + + ++ ++1 12 IND M 23 PATCHY 12 + ++ + ++

13 IND M 30 GUTTATE 4 ++ ++ ++ ++

TABLE . = = +++ - Marked Improvement I (F) FLUPEROLONE CH CHINESE ++ = Fair 1 (T)=TRIAMCINOLONE IND = IN DIRN = » + Slight ISQ= No change . ACETONIDE 0 =Worse. JUNE, 1964 71

CASE P-1742 TRIAMCINOLONE TAR . No. FLUPEROLONE ACETONIDE

1 +-i+ +++ ISQ

2 + ÷ I S Q

3 + ++ + 4 ++ + + 6 + ++ ISQ 7 0 0 ISQ

8 0 0 I S Q 9 + + 0

10 0 + I S Q

5 + ++ No previous 11 ++ ++ treatment 12 + ++ with TAR 13 -f-+ ++

TABLE IL. Comparison between Fluperolone and Triamcinolone and Tar. +++ = Marked Improvement. 0 = worse = Fair If ISQ = No change. + = Slight 'i 72 SINGAPORE MEDICAL JOURNAL became worse and they preferred the old side of the body or the left limbs, for a period treatment with tar. of 10 days to 2 weeks, after which occlusive treatment with a plastic cover was instituted From Table II, it would appear that flupero- for a further one to two weeks in 11 cases. lone and triamcinolone are superior to the treatment of topical tar ointment. There was It would appear that P-1742 (fluperolone) improvement in 10 out of the 13 cases with topical cream is somewhat less effective than fluperolone, and 11 out of the 13 cases with triamcinolone acetonide, but both were superior triamcinolone; and in one of these the condi- to the previous treatment with Tar. tion was markedly improved. However on Our impression is that in patients able to comparing fluperolone with triamcinolone, it tolerate occlusive therapy, there is a better would appear that triamcinolone was superior improvement in a significant number of to fluperolone in 5 cases, while fluperolone patients. was superior to triamcinolone in one case, and in 5 cases they were equally effective. ACKNOWLEDGEMENT Of the 11 cases under occlusive therapy, 2 We are grateful to Dr. Kirkup of Chas. became worse, but were no worse than without Pfizer & Co. for providing the fluperolone occlusion. Of the other 9 cases previously cream. The triamcinolone acetonide cream is treated with non -occlusive therapy, 4 showed marketed as Kenacort A (Squibb) cream. definite improvement, 4 were unchanged, and I failed to maintain previous improvement, on REFERENCES occlusion of the lesions. Cohen H. J. and Baer R. L. Invest. Derm. 34:271, 1960. SUMMARY AND CONCLUSION Readett M. D. Brit. J. Derm. 73: 107, 1961. Lawrence Frank and Y. Rapp. Arch. Derm. 87: 1, 13 cases of psoriasis of 1 year to 15 years 1963. duration were treated with fluperolone oint- New York Evaluation of Fluperolone Chas. Pfizer & ment on the right side of the body or the right Co. 1962. limbs, and triamcinolone acetonide on the left Oswald Morton. Brit. J. Derm. 74: 10, 1962.