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
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.
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Funding sources: None.
Conflicts of interest: None declared.