Single Blinded Left-to-Right Comparison Study of Excimer Laser Versus Pulsed Dye Laser for the Treatment of Nail Psoriasis

Abstract

IntroductionNail psoriasis is relatively difficult to treat. Excimer laser has been approved for the treatment of psoriasis since 2000. Pulsed dye laser (PDL) in psoriasis therapy has shown good response rates, with extended remissions. This is the first study assessing both the excimer and PDL lasers in nail psoriasis.MethodsIn a comparison study, excimer laser versus PDL for the treatment of nail psoriasis was evaluated in 42 patients. The right hand nails were treated with excimer laser twice weekly and the left hand nails were treated with PDL once every 4 weeks, for total 12 weeks. The patients were then followed up after a further 12 weeks. Nail Psoriasis Severity Index (NAPSI) scores were recorded at baseline, weeks 4, 8, and 12, and then at week 24. Patients were also asked to grade the clinical response to each treatment.ResultsA total of 304 nail changes, 148 with excimer laser and 156 with PDL, were treated. The mean NAPSI score in nails treated with excimer laser was 29.8 at baseline, reduced to 16.3 at week 24. In PDL-treated nails, the NAPSI scores dropped from 29.5 at baseline to 3.2 at week 24. NAPSI improvement was significantly greater in PDL than excimer (P = 0.001; Wilcoxon signed-rank test). Thirty-four (81%) hands achieved NAPSI-50, and 23 (55%) achieved NAPSI-75 at week 12, while complete nail recovery was shown in 6 (14%) hands treated with PDL. Regarding the hands treated with excimer laser, only 16 (38%) hands achieved NAPSI-50, while no hands achieved NAPSI-75 at week 12. In general, subungual hyperkeratosis and onycholysis improved significantly, while nail pitting was least responsive. Oil drops and splinter hemorrhages showed moderate response.ConclusionsWhen compared to excimer laser, PDL demonstrated a good response for treating nail psoriasis, with minimal side effects.Electronic supplementary materialThe online version of this article (doi:10.1007/s13555-014-0057-y) contains supplementary material, which is available to authorized users.

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.…”

Underdiagnosed and undertreated psoriasis: Nuances of treating psoriasis affecting the scalp, face, intertriginous areas, genitals, hands, feet, and nails

“…Another option for nail psoriasis is intralesional steroid‐injection therapy, which is limited by the pain of injection; however, recent data from a small ( N = 17) prospective trial suggested high efficacy for novel administration via needle‐free jet injector (Nantel‐Battista, Richer, Marcil, & Benohanian, ). Laser therapy can also be considered for patients with nail psoriasis and in a single blinded left‐to‐right comparison study ( N = 42), treatment with pulsed‐dye laser was significantly more effective than excimer laser (Al‐Mutairi, Noor, & Al‐Haddad, ). Additionally, the efficacies of pulsed‐dye laser and neodymium‐doped yttrium aluminum garnet (Nd:YAG) laser are comparable, but Nd:YAG laser therapy is more painful (Arango‐Duque, Roncero‐Riesco, Usero Bárcena, Palacios Álvarez, & Fernández López, ).…”

Non-pharmacological treatments of nail psoriasis and the assessment of therapeutic progress

“…Parameters of PDL were 8-10 J/cm 2 , pulse lenght of 30 nm and a 7 mm spot. In case of excimer laser the procedure was started from 2 × MED (minimal erythema dose) with subsequent uptitration of the dose by 200 mJ per session, up to 5000 mJ/cm 2 [30]. Authors suggest that the achieved effect could be a result of poor UVB penetration in the nail plate [31].…”

“…For that reason a topical pharmacotherapy of nail psoriasis will be used for a long time, particularly in cases of low advancement of the disease. o 200 mJ co sesję do 5000 mJ/cm 2 [30]. Autorzy sugerują, że osiągnięty efekt może być wynikiem słabej penetracji UVB przez płytkę paznokciową [31].…”