Indian Journal of Dermatology
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CORRESPONDENCE
Year : 2014  |  Volume : 59  |  Issue : 2  |  Page : 204
Pulsed dye laser for nail psoriasis: not the first time and apparently not that efficacious!


1 Department of Dermatology and Dermatosurgery, SKINNOCENCE: The Skin Clinic, Sushant Lok-1, Gurgaon, Haryana, India
2 Department of Dermatology and Sexually Transmitted Diseases, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
3 Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India

Date of Web Publication21-Feb-2014

Correspondence Address:
Sidharth Sonthalia
Department of Dermatology and Dermatosurgery, SKINNOCENCE: The Skin Clinic, Sushant Lok-1, Gurgaon, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.127699

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How to cite this article:
Sonthalia S, Arora R, Sarkar R. Pulsed dye laser for nail psoriasis: not the first time and apparently not that efficacious!. Indian J Dermatol 2014;59:204

How to cite this URL:
Sonthalia S, Arora R, Sarkar R. Pulsed dye laser for nail psoriasis: not the first time and apparently not that efficacious!. Indian J Dermatol [serial online] 2014 [cited 2019 Nov 14];59:204. Available from: http://www.e-ijd.org/text.asp?2014/59/2/204/127699


Sir,

We read with interest the report by Al-Mutairi and Elkashlan on treatment of nail psoriasis with pulsed dye laser (PDL), published in the May-June edition of the journal. [1] Authors reported a marked reduction in Nail Psoriasis Severity Index (NAPSI) score with improvement in both nail bed and nail matrix lesions after three treatment sessions given by 595 nm PDL monthly. However, this report needs to be critically reviewed for several reasons. In the introductory key learning points, authors clearly state "Pulse dye laser has proved effective for plaque-type psoriasis, but it has not been evaluated in nail psoriasis". [1] However, at least two studies evaluating the role of PDL in nail psoriasis had already been published by Fernández-Guarino et al. and Oram et al., respectively. [2],[3] Intriguingly, despite their original statement (vide supra), authors conclude with a mention of their results being compatible with those of Fernández-Guarino et al. and Oram et al. [1] Fernández-Guarino et al. were the first to try PDL for nail psoriasis in 14 patients and compared it with photodynamic therapy (PDT) in an intrapatient left-to-right study. They used a 595 nm PDL with 1.5 ms pulse duration, 7 mm beam diameter, and 9.0 J/cm 2 energy (parameters that are being followed in all subsequent reports), which was applied in isolation on nails of one hand, while the other side was treated with PDT followed by PDL. Monthly treatments given for 6 months resulted in significant reduction in pain and NAPSI score, which was comparable in both treatment groups. These results were published as early as August 2009. [2] Oram et al. reported similar reduction in NAPSI scores with PDL treatment sessions given monthly for 3 months in 5 patients and published their results in March 2010. [3] Secondly, the treatment response visible in pre- and post-laser photographs seems to be modest. Rather than a significant reduction in pitting, onycholysis, or subungual hyperkeratosis, improvement in paronychia is the most discernible in the photographs. Thirdly, authors gave only three treatment session at monthly intervals and followed the patient for only one month after treatment. In most of the similar studies including the pilot study by Fernández-Guarino et al. and recent studies by Treewittayapoom et al. and Huang et al., six sessions were given because 6 months is the time a nail plate takes to grow completely from matrix to hyponychium. [2],[3],[4],[5] This is most likely to be the cause for only modest response in their patient, visible in the pre- and post-treatment photographs. Additionally, the mechanism of action of PDL has been mentioned very briefly. Authors could have elaborated on the role of abnormal psoriatic vasculature and dermal angiogenesis in pathogenesis of psoriatic lesions by enhancing epidermal hyperplasia and acting as a conduit for lymphocytes, which are selectively targeted by the PDL. Curiously, authors have not mentioned anything about the tolerability of the procedure or adverse effects, though previous studies have shown pain lasting up to 24 hours as the major side effect, [3] others being transient petechiae and hyperpigmentation. [4]

 
   References Top

1.Al-Mutairi A, Elkashlan M. Nail psoriasis treated with pulse dye laser. Indian J Dermatol 2013;58:243.  Back to cited text no. 1
    
2.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. 2
    
3.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. 3
    
4.Treewittayapoom C, Singvahanont P, Chanprapaph K, Haneke E. The 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. J Am Acad Dermatol 2012;66:807-12.  Back to cited text no. 4
    
5.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. Lasers Surg Med 2013;45:102-7.  Back to cited text no. 5
    




 

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