Indian Journal of Dermatology
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E–CASE REPORT
Year : 2013  |  Volume : 58  |  Issue : 3  |  Page : 243
Nail psoriasis treated with pulse dye laser


Department of Dermatology, Ahmadi Hospital, Kuwait

Date of Web Publication20-Apr-2013

Correspondence Address:
Ahmed Al Mutairi
Head of Dermatology, Ahmadi Hospital, P. O. Box 9758, Ahmadi - 61008
Kuwait
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.110864

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   Abstract 

Pulse dye laser has proved effective for plaque-type psoriasis, but it has not been evaluated in nail psoriasis. We are reporting treatment of 10 psoriatic nails in one patient with pulse dye laser.


Keywords: Nail, psoriasis, pulse dye laser


How to cite this article:
Al Mutairi A, Elkashlan M. Nail psoriasis treated with pulse dye laser. Indian J Dermatol 2013;58:243

How to cite this URL:
Al Mutairi A, Elkashlan M. Nail psoriasis treated with pulse dye laser. Indian J Dermatol [serial online] 2013 [cited 2019 May 27];58:243. Available from: http://www.e-ijd.org/text.asp?2013/58/3/243/110864

What was known? Pulse dye laser has proved effective for plaque-type psoriasis, but it has not been evaluated in nail psoriasis



   Introduction Top


Nail affection is a common feature of psoriasis resulting in psychological and functional impairment for the affected patients. Pulse dye laser has proved effective for plaque-type psoriasis, but it has not been evaluated in nail psoriasis. We are reporting treatment of 10 psoriatic nails in one patient with pulse dye laser.


   Case Report Top


Our patient is 40 years old female suffering from nail pitting, onycholysis and subungual hyperkeratosis of the ten finger nails. She had this condition for the past two year. No other lesions were detected on the body. The patient has no family history of psoriasis. Direct KOH smear and culture for fungi where negative. Our diagnosis was nail psoriasis.

The nails were treated with PDL (595 nm, Candela Corp.) once monthly. The pulse duration was 1.5 ms, the beam diameter was 7 mm, and the laser energy was 8.0 to 10.0 J/cm. [1] Stacking technique was used. Three sessions were received. The nails were evaluated before treatment [Figure 1] and [Figure 2] and one month after the last session [Figure 3],[Figure 4],[Figure 5] using NAPSI score.
Figure 1: Right hand nails before treatment

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Figure 2: Left hand nails before treatment

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Figure 3: Right hand nails after treatment

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Figure 4: Left hand nails after treatment

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Figure 5: Both thumb nails after treatment

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NAPSI score markedly decreased. Both nail bed and nail matrix lesions improved. The patient was very happy with the result.


   Conclusion Top


Psoriasis is a chronic inflammatory skin condition that affects approximately 2% of the population. It has a profound emotional, social and physical impact on quality of life. Up to 50% of patients with psoriasis have concurrent nail psoriasis. Up to 30% of patients with skin psoriasis also have psoriatic arthritis (PsA) and of these, approximately 80% have nail disease. [2] Nail involvement is common at some point in the life of the patient with psoriasis. [1] Nail psoriasis in particular has a profound effect on manual dexterity. [2] Current treatment options for nail psoriasis are very often poorly efficacious, associated with undesirable effects, or time consuming. Success has to be measured in terms of months. [3] The availability of an effective treatment for this condition would be of great impact on the quality of life of those affected patients. Our results are compatible with the results of the pilot studies which showed pulse dye laser to be an effective treatment for nail psoriasis. [4],[5] The effectiveness may be due to destruction of abnormal vasculature. [4] We believe that PDL would be an effective convenient treatment option of nail psoriasis. However, more studies are needed to objectively judge its effect.

 
   References Top

1.De Berker D. Management of psoriatic nail disease. Semin Cutan Med Surg 2009;28:39-43.  Back to cited text no. 1
    
2.Reich K. Approach to managing patients with nail psoriasis. J Eur Acad Dermatol Venereol 2009;23:15-21.  Back to cited text no. 2
    
3.Wozel G. Psoriasis treatment in difficult locations: Scalp, nails, and intertriginous areas. Clin Dermatol 2008;26:448-59.  Back to cited text no. 3
    
4.Oram Y, Karincaoðlu Y, Koyuncu E, Kaharaman F. Pulsed dye laser in the treatment of nail psoriasis. Dermatol Surg 2010;36:377-81.  Back to cited text no. 4
    
5.Fernández-Guarino M, Harto A, Sánchez-Ronco M, García-Morales I, Jaén P. Pulsed dye laser vs. photodynamic therapy in the treatment of refractory nail psoriasis: A comparative pilot study. J Eur Acad Dermatol Venereol 2009;23:891-5.  Back to cited text no. 5
    

What is new? NAPSI scores were markedly decreased upon pulsed dye laser therapy of 10 nails in a psoriatic patient.


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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