Pulse-Dye Laser Followed by Betamethasone-Calcipotriol and Fractional Ablative CO₂-Laser-Assisted Delivery for Nail Psoriasis

BACKGROUND Nail psoriasis is a common and potentially debilitating condition for which no effective and safe nonsystemic therapy is currently available. Recently, laser-assisted drug delivery (LADD) is being increasingly used to facilitate transcutaneous penetration of topical treatments.OBJECTIVES We set to assess the efficacy and safety of combined pulse-dye laser and fractional CO2 laser-assisted betamethasonecalcipotriol gel delivery for the treatment of nail psoriasis.MATERIAL AND METHODS We conducted a prospective, intrapatient comparative study in a series of 22 patients with bilateral fingernail psoriasis. Nails on the randomized hand were treated with 3 monthly sessions of pulse-dye laser to the proximal and lateral nail folds followed by fractional ablative CO₂laser to the nail plate. Between treatments and one month following the last treatment, the participants applied betamethasone propionate-calcipotriol gel once daily to the nail plate. Clinical outcome was ascertained using nails photography, the Nail Psoriasis Severity Index (NAPSI) and patient satisfaction.RESULTSSeventeen completed the study. Three participants withdrew from the study because of treatment-associated pain. Treatment was associated with a statistically significant improvement of the NAPSI scale (p <.002). Patient satisfaction was high.CONCLUSION Combined PDL and fractional ablative CO₂-LADD of betamethasone-calcipotriol gel should be considered for the treatment of nail psoriasis.