Fractional CO2 Laser versus Fractional CO2 Laser Plus Betamethasone/Calcipotriol Ointment in the Treatment of Nail Psoriasis

Sharkawy, Dina Ahmed El; El-Komy, Mohamed H.M.; Sobhi, Rehab Mohamed; Raouf, Noura M Abdel; Fahim, Aya

doi:10.1097/dss.0000000000003791

Cited by 3 publications

(2 citation statements)

References 26 publications

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“…The results of our systematic literature review support the role of fractional laser treatment in the management of psoriasis while using topical medications. A total of 7 RCTs have been identified to date, out of which 4 were conducted as intra-patient studies [2,[10][11][12][13][14][15]. Despite the use of different topical medications and varying laser parameters across the studies, all of them have demonstrated a certain degree of reduction in NAPSI (although varying among the different studies).…”

Section: Discussionmentioning

confidence: 99%

Ablative CO2-Assisted Laser for Topical Drug Delivery in Nail Psoriasis: A Systematic Review

Tartaglia,

Piaserico,

Naldi

et al. 2023

Skin Appendage Disord

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Background: Nail psoriasis poses challenges for effective treatment, and topical drug delivery through the nail plate is limited. A novel approach to address this challenge involves the use of ablative fractional laser as a pretreatment strategy to enhance topical drug delivery for nail psoriasis. Summary: This systematic review, conducted in accordance with PRISMA guidelines, involved an extensive literature search across PubMed/MEDLINE, EMBASE, and the Cochrane Library up to July 2023. The primary focus was on exploring studies that investigated the application of ablative laser technology to augment drug delivery for nail psoriasis. Key Messages: (1) The review included seven randomized controlled trials, all examining the combination of fractional CO2 laser with topical treatments. These trials demonstrated varying degrees of improvement in nail psoriasis. (2) Patients undergoing laser treatment reported experiencing moderate levels of pain, effectively managed through the application of topical anesthesia. (3) Commonly observed side effects included erythema, swelling, and crusting, with the Koebner phenomenon being a rare occurrence. (4) Notably, patient satisfaction levels with the combined approach of laser and topical treatments were consistently high. In conclusion, the utilization of ablative CO2-assisted laser pretreatment, when used in conjunction with topical therapy, appears to be both effective and well-tolerated for the treatment of nail psoriasis. However, the establishment of optimal parameters and treatment intervals for fractional laser therapy remains an area for further research. Standardized studies are imperative to identify the most effective strategy for enhancing topical drug delivery in the context of nail psoriasis treatment.

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Section: Discussionmentioning

confidence: 99%

Ablative CO2-Assisted Laser for Topical Drug Delivery in Nail Psoriasis: A Systematic Review

Tartaglia,

Piaserico,

Naldi

et al. 2023

Skin Appendage Disord

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“…After the fractional laser beam penetrates the epidermis, drugs can diffuse from the epidermis into the dermis, promoting the transdermal absorption of topical drugs such as glucocorticoids. This also eliminates the pain of drug injection and reduces the risk of pigmentation 10 . The fractional CO 2 laser has been clinically studied for keloid treatment.…”

Section: Introductionmentioning

confidence: 99%

Application of fractional carbon dioxide laser monotherapy in keloids: A meta‐analysis

Wang,

Yu,

Zhou

et al. 2024

J of Cosmetic Dermatology

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BackgroundThere is no evidence‐based guidance on the use of fractional CO2 laser in the excision of scars.AimTo explore the effectiveness and safety of fractional CO2 laser in the treatment of keloids.MethodsIn this meta‐analysis, we searched the PubMed, Embase, and Cochrane databases from inception to April 2023. We only included studies reporting fractional CO2 laser treatment of keloids. We excluded duplicate published studies, incomplete studies, those with incomplete data, animal experiments, literature reviews, and systematic studies.ResultsThe pooled results showed that the Vancouver Scar Scale (VSS) parameters of height weighted mean difference (WMD) = −1.10, 95% confidence interval (CI): −1.46 to −0.74), pigmentation (WMD = −0.61, 95% CI: −1.00 to −0.21), and pliability (WMD = −0.90, 95% CI: −1.17 to −0.63) were significantly improved after fractional CO2 laser treatment of keloids. However, vascularity did not significantly change. Additionally, the total VSS was significantly improved after treatment (WMD = −4.01, 95% CI: −6.22 to −1.79). The Patient Scars Assessment Scale was significantly improved after treatment (WMD = −15.31, 95% CI: −18.31 to −12.31). Regarding safety, the incidences of hyperpigmentation, hypopigmentation, pain, telangiectasia, and atrophy were 5%, 0%, 11%, 2% (95% CI: 0%–6%), and 0% (95% CI: 0%–4%), respectively.ConclusionsFractional CO2 laser is effective in the treatment of keloids and can effectively improve the height, pigmentation, and pliability of scars, and patients are satisfied with this treatment. Further studies should explore the role of combination therapy.

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Lasers for the treatment of nail psoriasis: a systematic review

Jaalouk,

Algarin,

Pulumati

et al. 2024

Int J Dermatology

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This systematic review assesses the evidence concerning laser treatments for nail psoriasis (NP), a prevalent condition among individuals with cutaneous psoriasis that notably affects their quality of life. Traditional treatments have limitations in terms of drug delivery and poor patient adherence, leading to interest in laser therapies for their targeted approach, extended treatment intervals, and the potential to enhance topical medication effectiveness. The MEDLINE, Embase, Web of Science, and Cochrane Library databases were searched. English‐language randomized and non‐randomized controlled trials with full‐text availability were included. Data on the laser type, treatment protocol, Nail Psoriasis Severity Index (NAPSI) outcomes, and adverse events were extracted, and nail bed and matrix features and patient satisfaction were assessed. The primary effect measure was a percentage reduction in NAPSI scores from baseline. Nineteen studies involving the pulse dye laser (PDL), long‐pulsed neodymium:yttrium aluminum garnet (Nd:YAG) laser and fractional carbon dioxide laser (FCL) were identified. Lasers, particularly those used in conjunction with topical agents, have shown favorable results. PDL effectively lowered NAPSI scores, and the Nd:YAG laser had comparable effectiveness but more discomfort. FCL also shows promise, particularly for topical drug delivery. PDL and Nd:YAG laser treatment were more effective at reducing nail bed features, whereas FCL was effective at reducing both nail bed and matrix features. Overall, lasers are promising treatment alternatives for NP, with similar NAPSI outcomes to topical therapies and intralesional injections.

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Fractional CO2 Laser versus Fractional CO2 Laser Plus Betamethasone/Calcipotriol Ointment in the Treatment of Nail Psoriasis

Cited by 3 publications

References 26 publications

Ablative CO<sub>2</sub>-Assisted Laser for Topical Drug Delivery in Nail Psoriasis: A Systematic Review

Ablative CO<sub>2</sub>-Assisted Laser for Topical Drug Delivery in Nail Psoriasis: A Systematic Review

Application of fractional carbon dioxide laser monotherapy in keloids: A meta‐analysis

Lasers for the treatment of nail psoriasis: a systematic review

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