Nail psoriasis treated with pulsed dye laser

Abstract

Nail changes are present in about 50% of psoriasis patients and tend to be refractory to conventional treatments. Pulsed dye laser has emerged as an alternative therapy. Our aim is to evaluate the efficacy of pulsed dye laser in nail psoriasis and the impact of treatment on quality of life. Fourteen patients were treated in monthly sessions for three months. The outcome assesment was made by the Nail Psoriasis Severity Index (NAPSI). The median improvement in the scores of the overall NAPSI, nail bed NAPSI, and nail matrix NAPSI were 44.2% (P = 0.002), 50% (P = 0.033) and 65.1% (P = 0.024), respectively. Keywords: Lasers, dye; Laser therapy; Nails; Nail diseases; Psoriasis Psoriasis is a chronic inflammatory disease with a 2% prevalence in the world population. Nail changes are present in approximately 50% of these patients and may affect up to 80% of them at some time during their lives. 1 Even the mild forms of the disease have a negative impact on oexcluir quality of life. 2 Nail psoriasis (NP) is noted for being resistant to treatment. 3 Only 19.3% of the patients show significant improvement with the use of any topical treatment, and 77% of them would like to undergo a more effective treatment. 2 Pulsed dye laser (PDL) has emerged as a therapeutic alternative for NP and has been established as a therapeutic choice for treating plaque psoriasis. 4 This clinical trial was performed to assess the effectiveness of PDL in treating NP. The sample was calculated in 12 patients. To participate in this study, the patients could not have used systemic treatment or undergone phototherapy for at least eight weeks prior to the study, nor could they have undergone topical treatment for two weeks prior to the study or display onychomycosis or any other concomitant nail diseases.Three PDL (Candela Vbeam Perfecta ® , 595 nm pulsed dye laser) sessions were applied in four-week intervals, using the same application parameters for all participants: spot size 7 mm, pulse duration 0.45 ms, fluence 6J/cm².Three clinical assessments were performed: before the first session, in the third session, and 90 days after the treatment had ended. In each assessment, the NAPSI, a score that objectively assesses the intensity of nail impairment, was calculated. In addition, patients answered the DLQI (Dermatology Life Quality Index) questionnaire before and after treatment and, in their last appointment, answered a treatment assessment questionnaire.Fourteen patients participated in the study. The mean age ± standard deviation was 44.1 ± 16.4 years, and they had had nail changes for 7.2 ± 6.49 years.There was a significant reduction in NAPSI in follow-up (three months after the last session) compared to basal (P = 0.002) (Figure 1). The median (percentile 25 and percentile 75) improvement was 44.16% (7.08 and 65.63%) ( Table 1). An improvement was also detected in the analysis of the nail bed NAPSI (P = 0.033). The median (p25 and p75) was 50% (1.67 and 73.86%).Nail matrix changes were detected in ten of the 14 patients.The nail ma...

Treatment of nail psoriasis with calcipotriol/betamethasone dipropionate foam versus pulse dye laser: an unblinded, intra‐patient, left‐to‐right prospective study

“…Although the application parameters of the 595-nm PDL were in part comparable with that of prior studies, [4][5][6][7][8][9] we observed a disparity in effectiveness that could be attributed to fewer sessions or non-use of concomitant therapy in our cohort.…”

Nonvascular uses of pulsed dye laser in clinical dermatology

“…Nail psoriasis is graded with the Nail Psoriasis Severity Index, otherwise known as NAPSI score. NAPSI scores improved in nail psoriasis treated with PDL monotherapy but no significant difference was found between varying pulse durations of PDL and NAPSI scores, although both durations (6 and 0.45ms, respectively) were found to be efficacious . PDL was found to be more effective in treating nail psoriasis than excimer laser but interestingly less effective in plaque psoriasis .…”

Successful Treatment of Dystrophic Nails Caused by Onychotillomania Using Pulsed Dye Laser 595 nm: A Case Report

“…PDL was selected as an appropriate treatment option in this case because it has been documented as a practical solution for dystrophic nails associated with psoriasis. 20 , 21 Possible PDL action mechanism in psoriatic nails, including selectively eliminating abnormal vasculature and reducing inflammation by decreasing the T-lymphocyte count on the skin. 21…”