Nail psoriasis treated with pulse dye laser.

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.

What was known?

Pulse dye laser has proved effective for plaque-type psoriasis, but it has not been evaluated in nail psoriasis.

Introduction

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

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 [Figures 1 and 2] and one month after the last session [Figures 3-5] using NAPSI score.

Figure 1

Right hand nails before treatment

Figure 2

Left hand nails before treatment

Figure 3

Right hand nails after treatment

Figure 5

Both thumb nails after treatment

Left hand nails after treatment

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

Conclusion

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.[45] 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.

What is new?

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