Single Blinded Left-to-Right Comparison Study of Excimer Laser Versus Pulsed Dye Laser for the Treatment of Nail Psoriasis.
Single Blinded Left-to-Right Comparison Study of Excimer Laser Versus Pulsed Dye Laser for the Treatment of Nail Psoriasis.
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DOI：
10.1007/s13555-014-0057-y
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发表时间：
2014-12
影响因子：
3.4
通讯作者：
Al-Haddad, Ahmed
中科院分区：
文献类型：
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作者：
Al-Mutairi, Nawaf;Noor, Tarek;Al-Haddad, Ahmed
指甲银屑病相对较难治疗，自2000年以来准分子激光已被批准用于治疗银屑病。脉冲染料激光（PDL）在银屑病治疗中表现出良好的反应率，延长缓解。这是第一个研究评估准分子和PDL激光在指甲银屑病。在一项比较研究中，准分子激光与PDL治疗甲银屑病的42例患者进行了评价。右侧甲用准分子激光治疗，每周2次，左手甲用PDL治疗，每4周1次，共12周。患者在12周后接受随访。在基线、第4、8和12周以及第24周记录指甲银屑病严重程度指数（NAPSI）评分。还要求患者对每种治疗的临床反应进行分级。共治疗了304例指甲变化，148例采用准分子激光，156例采用PDL。用准分子激光治疗的指甲的平均NAPSI评分在基线时为29.8，在第24周时降低至16.3。在PDL治疗的指甲中，NAPSI评分从基线时的29.5降至第24周时的3.2。PDL患者的NAPSI改善显著大于准分子组（P = 0.001; Wilcoxon符号秩检验）。在第12周时，34只（81%）手达到NAPSI-50，23只（55%）达到NAPSI-75，而在6只（14%）接受PDL治疗的手中显示指甲完全恢复。对于用准分子激光治疗的手，只有16只（38%）手在第12周达到NAPSI-50，而没有手达到NAPSI-75。一般来说，甲下角化过度和甲松解明显改善，而指甲凹陷反应最小。油滴和碎片碎屑显示出中度反应。与准分子激光相比，PDL对治疗指甲银屑病表现出良好的反应，副作用最小。本文的在线版本（doi：10.1007/s13555-014-0057-y）包含补充材料，可供授权用户使用。
Nail psoriasis is relatively difficult to treat. Excimer laser has been approved for the treatment of psoriasis since 2000. Pulsed dye laser (PDL) in psoriasis therapy has shown good response rates, with extended remissions. This is the first study assessing both the excimer and PDL lasers in nail psoriasis. In a comparison study, excimer laser versus PDL for the treatment of nail psoriasis was evaluated in 42 patients. The right hand nails were treated with excimer laser twice weekly and the left hand nails were treated with PDL once every 4 weeks, for total 12 weeks. The patients were then followed up after a further 12 weeks. Nail Psoriasis Severity Index (NAPSI) scores were recorded at baseline, weeks 4, 8, and 12, and then at week 24. Patients were also asked to grade the clinical response to each treatment. A total of 304 nail changes, 148 with excimer laser and 156 with PDL, were treated. The mean NAPSI score in nails treated with excimer laser was 29.8 at baseline, reduced to 16.3 at week 24. In PDL-treated nails, the NAPSI scores dropped from 29.5 at baseline to 3.2 at week 24. NAPSI improvement was significantly greater in PDL than excimer (P = 0.001; Wilcoxon signed-rank test). Thirty-four (81%) hands achieved NAPSI-50, and 23 (55%) achieved NAPSI-75 at week 12, while complete nail recovery was shown in 6 (14%) hands treated with PDL. Regarding the hands treated with excimer laser, only 16 (38%) hands achieved NAPSI-50, while no hands achieved NAPSI-75 at week 12. In general, subungual hyperkeratosis and onycholysis improved significantly, while nail pitting was least responsive. Oil drops and splinter hemorrhages showed moderate response. When compared to excimer laser, PDL demonstrated a good response for treating nail psoriasis, with minimal side effects. The online version of this article (doi:10.1007/s13555-014-0057-y) contains supplementary material, which is available to authorized users.