Is the efficacy of topical corticosteroid therapy for psoriasis vulgaris enhanced by concurrent moclobemide therapy? A double-blind, placebo-controlled study

Psychosocial factors have been implicated in the onset and exacerbation of psoriasis. We conducted a randomized, placebo-controlled, double-blind study to investigate the effect of an antidepressant agent, moclobemide, on the course of psoriasis vulgaris. Sixty subjects were enrolled in the study. Patients were randomly assigned to treatment groups. Patients received moclobemide 450 mg/day or placebo and a topical corticosteroid ointment (diflucortolone valerate) for 6 weeks. Patients were examined at the beginning of the study and at 2-week intervals. At each visit, the severity of psoriasis and psychologic status were evaluated with the Psoriasis Area Severity Index (PASI), Beck Depression Inventory (BDI), Hamilton Rating Scale for Anxiety (HAM-A), Hamilton Rating Scale for Depression (HRS-D-17) and State-Trait Anxiety Inventory including state (STAI-1) and trait anxiety (STAI-2). Treatment efficacy was able to be evaluated in 22 patients in the moclobemide-treated group and in 20 in the placebo-treated group. The improvement rates in PASI, BDI, STAI-1, and HAM-A scores were significantly higher in the moclobemide treatment group. The level of state anxiety was diminished in the moclobemide group. Correlation was positive between improvement rates of the psoriatic lesions and state anxiety in all patients. Our results suggest that an antidepressant drug is useful in the treatment of psoriasis.