الفهرس 
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Abstract
Introduction : Psoriasis is a chronic inflammatory immune mediated skin disease that is accompanied by significant emotional and social disabilities even with localized lesions in face or extremities that had long been called ‘the badge of shame’ (Shah and Bewley, 2014; Alhammad et al., 2021). Many treatment options are available for localized psoriasis but each has its limitations and is not without side effects. Therefore the need for an effective topical agent that delivers the drug efficiently into the target site with minimal systemic side effects remains an aim in itself (Armstrong and Read, 2020).Methotrexate (MTX) is a cytotoxic drug with powerful anti-proliferative and anti-inflammatory effects that had gained prominence in treating psoriasis. To reduce the hepatotoxic and hematologic adverse effects through systemic administration and to use it in treatment of localized lesions, there has been a major interest in using MTX topically (Huang et al., 2021). Calcipotriol (vitamin D analogue) is widely used in clinical practice to treat localized plaque psoriasis owing to its anti-proliferative and anti-inflammatory effects (Parker et al., 2021). The Aim of this study : The aim of the present study was to evaluate the efficacy and tolerability of topical MTX 1% hydrogel in comparison to topical Calcipotriol 0.005% cream in the treatment of localized plaque psoriasis. Materials and methods : This is a comparative study carried out on 40 patients with more or less symmetrical lesions of localized plaque psoriasis affecting either legs or arms recruited from Dermatology Outpatient Clinic at Mansoura University Hospitals. Patients were instructed to apply MTX 1% gel (container A) on the right side lesions and calcipotriol 0.005% cream (container B) on the left side lesions twice daily for 12 weeks. Accordingly lesions were allocated into 2 groups:- group A : Psoriatic plaques on the right upper or lower extremity treated with MTX 1% gel. group B: Psoriatic plaques on the left upper or lower extremity treated with CPL 0,005% cream. At the end of 12 weeks, there was marked to complete improvement in 97.5% of group A lesions treated with MTX 1% gel compared to 37.5% of group B lesions treated with calcipotriol 0.005% cream (P < 0.001). There was a very high statistically significant improvement in erythema that was cleared totally in 67.5% vs 22.5%, scaling in 75% vs 17.5% and infiltration in 72.5% vs 27.5% in group A vs B respectively (p <0.001). These results were confirmed by dermoscopic and immunohistopathological findings. MTX 1% gel is a marvelous promising well tolerated effective topical agent that can be used safely in the treatment of localized plaque psoriasis.