The effect of different pulse durations in the treatment of nail psoriasis with 595-nm pulsed dye laser: A randomized, double-blind, intrapatient left-to-right study

doi:10.1016/j.jaad.2011.12.015

Journal of the American Academy of Dermatology

Volume 66, Issue 5, May 2012, Pages 807-812

https://doi.org/10.1016/j.jaad.2011.12.015 Get rights and content

Background

Several studies have proven the efficacy of pulsed dye laser (PDL) in the treatment of plaque type psoriasis. However, only two published studies indicate the effectiveness of PDL on nail psoriasis.

Objective

We sought to study the effect of different pulse durations in the treatment of nail psoriasis with the 595-nm PDL to determine the optimal pulse duration.

Methods

Twenty patients with bilateral fingernail psoriasis were recruited and completed a 6-month trial. PDL was applied on the proximal and lateral nailfolds based on random assignment. Forty nails were treated with 6-millisecond pulse duration and 9 J/cm² whereas 39 nails were treated with 0.45-millisecond pulse duration and 6 J/cm². Patients were blinded to pulse durations. One blinded dermatologist used the Nail Psoriasis Severity Index (NAPSI) to assess the clinical outcome from pretreatment and posttreatment photographs. Patients were monitored for adverse events. Pain was evaluated after the procedure using a visual analog scale assessed by the patient.

Results

After 6 months of first treatment, there was a significant reduction in overall NAPSI, nail matrix NAPSI, and nail bed NAPSI scores from baseline in both groups; however, no significant difference was found between the two pulse duration groups. Side effects were mild including transient petechiae and hyperpigmentation.

Limitations

There was no placebo group.

Conclusions

PDL was found to be an effective and well-tolerated option in the treatment of nail psoriasis. No significant difference in terms of efficacy was found between the longer and shorter pulse duration treatment groups.

Section snippets

Patient selection

Twenty patients (13 female, 7 male), 18 to 75 years of age, in good general health, with recalcitrant, bilateral fingernail psoriasis were recruited from the Dermatology Outpatient Clinic, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, between September 2009 and April 2010. The diagnosis was based upon the clinical characteristics of nail psoriasis. The following patients were excluded: individuals with more than 30% body surface area of chronic plaque type psoriasis; those having

Results

All 20 patients completed the 6-month protocol (Fig 1). Patient characteristics are shown in Table I. There were 40 fingernails treated in the 6-millisecond longer pulse duration group, and 39 fingernails treated in the 0.45-millisecond shorter pulse duration group. NAPSI score at baseline for nail matrix and nail bed are shown in Table II.

Total mean NAPSI score at baseline in the 6- and 0.45-millisecond PDL groups were 10.05 ± 3.16 and 10.26 ± 3.91, respectively (Fig 2, A). There were no

Discussion

Psoriatic lesions improve with PDL treatment by the obliteration of their supporting vasculature. Many studies have already shown the efficacy of PDL in the treatment of plaque type psoriasis, which exhibits the characteristics of angiogenesis and increased vascularity. Besides destruction of blood vessels, PDL can reduce the number of helper T cells in the dermis and cytotoxic T cells in the epidermis, and normalize epidermal proliferation, which improves the clinical signs of psoriasis

Conclusion

Both the longer 6-millisecond and shorter 0.45-millisecond pulses of PDL (595 nm) have been clinically proven to be effective for the treatment of nail matrix and nail bed psoriasis. There was no significant difference in terms of efficacy between both groups. We conclude that PDL is safe, is well tolerated, and could be considered as an optional treatment for nail psoriasis.

References (33)

M.M. Jiaravuthisan et al.
Psoriasis of the nail: anatomy, pathology, clinical presentation, and a review of the literature on therapy
J Am Acad Dermatol
(2007)
P. Rich et al.
Nail Psoriasis Severity Index: a useful tool for evaluation of nail psoriasis
J Am Acad Dermatol
(2003)
J. De Leeuw et al.
Concomitant treatment of psoriasis of the hands and feet with pulsed dye laser and topical calcipotriol, salicylic acid, or both: a prospective open study in 41 patients
J Am Acad Dermatol
(2006)
I.M. Braverman et al.
Ultrastructure of the capillary loops in the dermal papillae of psoriasis
J Invest Dermatol
(1977)
E.M. de Jong et al.
Psoriasis of the nails associated with disability in a large number of patients: results of a recent interview with 1,728 patients
Dermatology
(1996)
Ş Aktan et al.
Interobserver reliability of the Nail Psoriasis Severity Index
Clin Exp Dermatol
(2006)
D.A. de Berker et al.
A simplified protocol of steroid injection for psoriatic nail dystrophy
Br J Dermatol
(1998)
R.M. Sanchez et al.
Treatment of nail psoriasis with 8% clobetasol nail lacquer: positive experience in 10 patients
J Eur Acad Dermatol Venereol
(2005)
R.M. Sanchez et al.
Nail psoriasis: a combined treatment with 8% clobetasol nail lacquer and tacalcitol ointment
J Eur Acad Dermatol Venereol
(2008)
A. Tosti et al.
Calcipotriol ointment in nail psoriasis: a controlled double-blind comparison with betamethasone dipropionate and salicylic acid
Br J Dermatol
(1998)

T.Y. Tzung et al.

Calcipotriol used as monotherapy or combination therapy with betamethasone dipropionate in the treatment of nail psoriasis

Acta Derm Venereol

(2008)

D. Rigopoulos et al.

Nail psoriasis: a combined treatment using calcipotriol cream and clobetasol propionate cream

Acta Derm Venereol

(2002)

A. Tosti et al.

Evaluation of the efficacy of acitretin therapy for nail psoriasis

Arch Dermatol

(2009)

R.K. Scher et al.

Tazarotene 0.1% gel in the treatment of fingernail psoriasis: a double-blind, randomized, vehicle-controlled study

Cutis

(2001)

D. Rigopoulos et al.

Treatment of psoriatic nails with tazarotene cream 0.1% vs clobetasol propionate 0.05% cream: a double-blind study

Acta Derm Venereol

(2007)

T. Yamamoto et al.

Topical anthralin therapy for refractory nail psoriasis

J Dermatol

(1998)

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Dermatologic surgeryThe effect of different pulse durations in the treatment of nail psoriasis with 595-nm pulsed dye laser: A randomized, double-blind, intrapatient left-to-right study

Background

Objective

Methods

Results

Limitations

Conclusions

Section snippets

Patient selection

Results

Discussion

Conclusion

J Am Acad Dermatol

J Am Acad Dermatol

J Am Acad Dermatol

J Invest Dermatol

Psoriasis of the nails associated with disability in a large number of patients: results of a recent interview with 1,728 patients

Dermatology

Interobserver reliability of the Nail Psoriasis Severity Index

Clin Exp Dermatol

A simplified protocol of steroid injection for psoriatic nail dystrophy

Br J Dermatol

Treatment of nail psoriasis with 8% clobetasol nail lacquer: positive experience in 10 patients

J Eur Acad Dermatol Venereol

Nail psoriasis: a combined treatment with 8% clobetasol nail lacquer and tacalcitol ointment

J Eur Acad Dermatol Venereol

Calcipotriol ointment in nail psoriasis: a controlled double-blind comparison with betamethasone dipropionate and salicylic acid

Br J Dermatol

Calcipotriol used as monotherapy or combination therapy with betamethasone dipropionate in the treatment of nail psoriasis

Acta Derm Venereol

Nail psoriasis: a combined treatment using calcipotriol cream and clobetasol propionate cream

Acta Derm Venereol

Evaluation of the efficacy of acitretin therapy for nail psoriasis

Arch Dermatol

Tazarotene 0.1% gel in the treatment of fingernail psoriasis: a double-blind, randomized, vehicle-controlled study

Cutis

Treatment of psoriatic nails with tazarotene cream 0.1% vs clobetasol propionate 0.05% cream: a double-blind study

Acta Derm Venereol

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J Dermatol

Dermatologic surgery
The effect of different pulse durations in the treatment of nail psoriasis with 595-nm pulsed dye laser: A randomized, double-blind, intrapatient left-to-right study