Nd:YAG Laser in the Treatment of Nail Psoriasis: Clinical and Dermoscopic Assessment
Keywords:
Nd:YAG laser, nail psoriasis, NAPSI, dermoscopyAbstract
Background: The Nd:YAG laser has emerged as a promising modality for the management of nail psoriasis owing to its ability for deep penetration of the skin surface, which has the advantage of destroying deep vessels.
Objective: To assess the efficacy and safety of Nd:YAG laser in treating nail psoriasis.
Methods: The present study was a randomized controlled study, conducted on 20 patients of both sexes (age older than 12 years) with mild to moderate psoriasis with nail involvement. We utilized facial telangiectasia parameters of Nd:YAG laser and beam diameter of 2.5 mm. Laser energy started with 110 J/cm2 in the first session and 130 J/cm2 in the rest of the sessions. Sessions were performed once monthly for up to 6 sessions.
Results: We found no statistically significant difference in total Nail Psoriasis Severity Index (NAPSI) and nail bed scores before and after treatment among the treated group. However, there was statistically significant improvement in nail matrix score after treatment. On the other hand, the control group did not show any statistically significant changes for all scores throughout the study, except for the nail matrix score mean difference (0.35 ± 1.23 vs -1.00 ± 1.86 in the treated group). The degree of dermoscopic improvement was evident in the treated group (45% vs 25% in the control group). However, it was not statistically significant because of small sample size. The patients’ satisfaction and the external investigator’s assessment showed statistically significant negative correlation with total NAPSI mean difference in the treated group.
Conclusion: The role of Nd:YAG laser in nail psoriasis is still controversial.
References
Bardazzi F, Starace M, Bruni F, Magnano M, Piraccini BM, Alessandrini A. Nail psoriasis: an updated review and expert opinion on available treatments, including biologics. Acta Derm Venereol. 2019 99(6):516-523. DOI: 10.2340/00015555-3098. PMID: 30521057.
Arango-Duque LC, Roncero-Riesco M, Bárcena TU, Álvarez IP, López EF. Treatment of nail psoriasis with pulse dye laser plus calcipotriol betametasona gel vs. Nd:YAG plus calcipotriol betamethasone gel: an intrapatient left-to-right controlled study. Actas Dermosifiliogr. 2017;108(2):140-144. DOI: 10.1016/j.ad.2016.09.009. PMID: 28118926.
Yin N, Choudhary S, Nouri K. Pulsed dye laser for the treatment of nail psoriasis. Cutis. 2013;92(3):129-135. PMID: 24153141.
Huang YC, Chou CL, Chiang YY. Efficacy of pulsed dye laser plus topical tazarotene versus topical tazarotene alone in psoriatic nail disease: a single‐blind, intrapatient left‐to‐right controlled study. Laser Surg Med. 2013;45(2):102-107. DOI: 10.1002/lsm.22122. PMID: 23423871.
Al-Mutairi N, Noor T, Al-Haddad A. Single blinded left-to-right comparison study of excimer laser versus pulsed dye laser for the treatment of nail psoriasis. Dermatol Ther. 2014;4(2):197-205. DOI: 10.1007/s13555-014-0057-y. PMID: 24990703.
Kartal SP, Canpolat F, Gonul M, Ergin C, Gencturk Z. Long-pulsed Nd:YAG laser treatment for nail psoriasis. Dermatol Surg. 2018;44(2):227–233. DOI:10.1097/DSS.0000000000001294. PMID: 29016537.
Yadav TA, Khopkar US. Dermoscopy to detect signs of subclinical nail involvement in chronic plaque psoriasis: A study of 68 patients. Indian J Dermatol. 2015;60(3):272–275. DOI: 10.4103/0019-5154.156377. PMID: 26120154.
Rich P, Scher RK. Nail Psoriasis Severity Index: A useful tool for evaluation of nail psoriasis. J Am Acad Dermatol. 2003;49:206–212. DOI: 10.1067/S0190-9622(03)00910-1. PMID: 12894066.
Zalaudek I, Argenziano G, Di Stefani A, et al. Dermoscopy in general dermatology. Dermatology. 2006;212:7–18. DOI: 10.1159/000089015. PMID: 16319467.
Khashaba SA, Gamil H, Salah R, Salah E. Efficacy of long-pulsed Nd-YAG laser in the treatment of nail psoriasis: a clinical and dermoscopic evaluation. J Dermatol Treat. 2019:1-7. DOI: 10.1080/09546634.2019.1668908. PMID: 31524008.
Klaassen KMG, Van De Kerkhof PCM, Bastiaens MT, Plusjé LGJM, Baran RL, Pasch MC. Scoring nail psoriasis. J Am Acad Dermatol. 2014;70:1061–1066. DOI: 10.1016/j.jaad.2014.02.010. PMID: 24698704.
Yadav TA, Khopkar US, Dermoscopy to detect signs of subclinical nail involvement in chronic plaque psoriasis: A study of 68 patients. Indian J Dermatol. 2015;60(3):272-275. DOI: 10.4103/0019-5154.156377. PMID: 26120154.
Shen JH, Chang CC, Chen YT, Hsih CJ, Huang H, Lin BS. Using a low fluence Q-switched 532/1064-nm Nd:YAG laser for facial skin depigmentation in asian patients: outcome and complication profile analysis. Ann Plast Surg. 2016;77:S32–S35. DOI: 10.1097/SAP.0000000000000844. PMID: 27404474.
Published
Issue
Section
License
Dermatology Practical & Conceptual applies a Creative Commons Attribution License (CCAL) to all works we publish (http://creativecommons.org/licenses/by-nc/4.0/). Authors retain the copyright for their published work.
How to Cite
Share
