Efficacy and safety of Pulsed Dye, Neodymium-Doped Yttrium Aluminum Garnet, Fractional CO2 Lasers compared to Betamethasone/Calcipotriol topical ointment in the treatment of nail psoriasis

Efficacy and safety of Pulsed Dye, Neodymium-Doped Yttrium Aluminum Garnet, Fractional CO2 Lasers compared to Betamethasone/Calcipotriol topical ointment in the treatment of nail psoriasis

Interventional, randomized clinical trial with a control group, with parallel groups, block randomized, phase 2 on 40 patients

40 patients randomly underwent 3 treatments with Nd:YAG 1064-nm lasers, Pulsed Dye Laser or Fractional CO2 Laser with 3-week intervals in the Razi hospital, Tehran University of Medical Sciences and all patients are treated daily with betamethasone/calcipotriol topical ointment. Follow-up of patients will be done based on the level of satisfaction of two dermatologists with the improvement of patients based on the nail psoriasis severity index.

Inclusion criteria: adults between 18 and 65 years old with psoriasis, mild to moderate bilateral involvement of nails with negative smear and negative culture for onychomycosis. Exclusion criteria: pregnancy and breastfeeding, use of local and systemic treatments during the last 3 months, severe disease requiring systemic treatments, erythrodermic, pustular or drug related psoriasis, severe joint involvement, active bacterial or viral infection in treatment area, history of skin cancers, uncontrolled systemic disease, photosensitivity, history of seizures, history of hypertrophic and keloid scars, hematoma or subungual nevus, and history of nail trauma in the past 3 months

3 intervention groups treated with Pulsed Dye Laser (VBeam Perfecta Candela), Nd:YAG 1064-nm (Candela Gentle Pro Max) and Fractional CO2 Laser (Edge One, Jeisys) every 3 weeks and all 4 study groups treated with betamethasone/calcipotriol topical ointment

Nail Psoriasis Severity Index based on 32 and 8 points "Nail Psoriasis Severity Index"

The research population includes patients who are referred to the Razi Skin Hospital of Tehran University of Medical Sciences with a definitive diagnosis of psoriasis, and the NAPSI criteria have been recorded for all their affected nails. Patients will be placed in four groups randomly and through the block randomization method, and based on this grouping, they will receive the required treatment during different follow-up periods. These people are randomly treated 3 times with Nd:YAG 1064-nm lasers (Candela Gentle Max Pro), Pulsed Dye Laser (VBeam Perfecta Candela), Fractional CO2 Laser (Edge One, Jeisys) with 4-week intervals and a A group of patients are also treated daily with betamethasone/calcipotriol topical ointment. Random allocation of patients to group A (Nd:YAG 1064-nm (Candela Gentle Max Pro)), group B (Pulsed Dye Laser (VBeam Perfecta Candela)), group C (Fractional CO2 Laser (Edge One, Jeisys)) and group D (local treatment) is done through block randomization method. To prepare a random list, the table of random numbers is used in such a way that a random number is generated at each stage. If the generated number was 1 or 2, patients will receive group A treatment (Nd:YAG 1064-nm (Candela Gentle Max Pro)), if the generated number was 3 or 4, patients will receive group B treatment (Pulsed Dye Laser ( VBeam Perfecta Candela)), if the generated number was 5 or 6, patients will receive treatment group C (Fractional CO2 Laser (Edge One, Jeisys)), and if the generated number was 7 or 8, patients will receive treatment group (local therapy). Therefore, we repeat this process many times until eligible patients enter the study.

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