טיפול משולב בלייזר הבזק-צבע והחדרת בטאמיטזון-קלציפוטריול בסיוע לייזר אבלטיבי מקטעי מסוג CO2 לטיפול בציפורניים נגועות בפסוריאזיס

Background

Nail psoriasis affects 60-80% of psoriasis patients. Most therapies are only partially effective. Pulse-dye and long-pulse Nd-YAG lasers have been reported to improve the condition.

Objective

We aimed at assessing efficacy and safety of sequential treatment with pulse-dye laser (PDL) and fractional CO2 laser (FACL)-assisted betamethasone-calcipotriol gel (BC) delivery for the treatment of nail psoriasis.

Methods

We performed a prospective, intra-patient comparative study, treating one hand while the other hand served as control. 22 participants with bilateral fingernail psoriasis were enrolled. Randomized hands were treated with 3 monthly sessions of PDL to the proximal and lateral nail folds followed immediately by FACL- assisted BC delivery to the nail plate. In the month following each treatment, participants applied BC once daily to the nail plate. At baseline and follow-up visits (5, 8 and 11 months) the nails were photographed and Nail Psoriasis Severity Index (NAPSI) was calculated.

Results

Seventeen of the 22 patients enrolled completed the study. The treatment was mostly well tolerated except for 3 participants who withdrew due to pain during treatment. The participants demonstrated statistically significant improvement in NAPSI scale of the treated side at 11 months(14.12 vs 19.43) including nail bed (5.87 vs 8.31) and nail matrix (8.25 vs 11.06). Every NAPSI parameter responded differently to treatment. Patient satisfaction was high and averaged 2.06 (scale 0-3).

Conclusion

Combined vascular laser (PDL) and lase-assisted BC drug delivery resulted in significant improvement of nail psoriasis.