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Controlled study of excimer and pulsed dye lasers in the treatment of psoriasis.

Abstract

BACKGROUND AND OBJECTIVES

The excimer laser delivers high energy monochromatic ultraviolet (UV) B at 308 nm. Advantages over conventional UV sources include targeting of lesional skin, reducing cumulative dose and inducing faster clearance. Studies of the pulsed dye laser (PDL) in psoriasis report between 57% and 82% response rates; remission may extend to 15 months. To our knowledge, this is the first study assessing both excimer and PDL in psoriasis.

METHODS

We conducted a within-patient controlled prospective trial of treatment of localized plaque psoriasis. Twenty-two adult patients, mean Psoriasis Area and Severity Index 7.1, were recruited. Fifteen patients completed the full treatment, of which 13 were followed up to 1 year. Two selected plaques were treated with excimer twice weekly and V Beam PDL, pretreated with salicylic acid (SA), every 4 weeks, respectively. Two additional plaques, treated with SA alone or untreated, served as controls. The primary outcome measures were: (i) changes in plaque-modified Psoriasis Activity and Severity Index (PSI) scores from baseline to end of treatment; (ii) clinical response to treatment (CR(T)), assessed by serial photographs; (iii) percentage of plaques clear at the end of treatment; and (iv) percentage of plaques clear at 1-year follow-up. The secondary outcome measures were: (i) number of laser treatments to clearance; (ii) time to relapse; (iii) frequency of side-effects; and (iv) qualitative observations with SIAscope.

RESULTS

The mean improvement in PSI was 4.7 (SD 2.1) with excimer and 2.7 (SD 2.4) with PDL. PSI improvement was significantly greater in excimer than PDL (P = 0.003) or both control plaques (P < 0.001). CR(T) indicated 13 patients responded best with excimer, two patients best with PDL, and in seven patients there was no difference between the two lasers. CR(T) was significantly greater for excimer than PDL (P = 0.003) or both controls (P < 0.001). CR(T) was also significantly greater for PDL than SA alone (P = 0.004) or untreated control (P =0.002). Nine (41%) patients cleared with excimer, after mean 8.7, median 10 weeks treatment. Seven of these nine patients were followed up to 1 year; four remained clear, two relapsed at 1 month, and one at 6 months. Six (27%) patients cleared with PDL, after mean 3.3, median four treatments. All six patients were followed up to 1 year; four remained clear, one relapsed at 4 months and one at 9 months. Despite common side-effects including blistering and hyperpigmentation, patient satisfaction was high. Serial images obtained with the SIAscope during treatment indicated different mechanisms of action of the two lasers.

CONCLUSIONS

Excimer and V Beam PDL are useful treatments for plaque psoriasis. Although the excimer appears to be on average more efficacious, a subset of patients may respond better to PDL. Long-term remission is achievable with both lasers.

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  • Authors+Show Affiliations

    ,

    Lasercare Clinics, City Hospital, Dudley Road, Birmingham B18 7QH, UK. saleemtaibjee@blueyonder.co.uk

    , ,

    Source

    The British journal of dermatology 153:5 2005 Nov pg 960-6

    MeSH

    Adult
    Aged
    Combined Modality Therapy
    Female
    Humans
    Hyperpigmentation
    Keratolytic Agents
    Laser Therapy
    Lasers
    Male
    Middle Aged
    Prospective Studies
    Psoriasis
    Recurrence
    Salicylic Acid
    Severity of Illness Index
    Treatment Outcome
    Ultraviolet Therapy

    Pub Type(s)

    Comparative Study
    Controlled Clinical Trial
    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    16225606

    Citation

    Taibjee, S M., et al. "Controlled Study of Excimer and Pulsed Dye Lasers in the Treatment of Psoriasis." The British Journal of Dermatology, vol. 153, no. 5, 2005, pp. 960-6.
    Taibjee SM, Cheung ST, Laube S, et al. Controlled study of excimer and pulsed dye lasers in the treatment of psoriasis. Br J Dermatol. 2005;153(5):960-6.
    Taibjee, S. M., Cheung, S. T., Laube, S., & Lanigan, S. W. (2005). Controlled study of excimer and pulsed dye lasers in the treatment of psoriasis. The British Journal of Dermatology, 153(5), pp. 960-6.
    Taibjee SM, et al. Controlled Study of Excimer and Pulsed Dye Lasers in the Treatment of Psoriasis. Br J Dermatol. 2005;153(5):960-6. PubMed PMID: 16225606.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Controlled study of excimer and pulsed dye lasers in the treatment of psoriasis. AU - Taibjee,S M, AU - Cheung,S-T, AU - Laube,S, AU - Lanigan,S W, PY - 2005/10/18/pubmed PY - 2006/2/4/medline PY - 2005/10/18/entrez SP - 960 EP - 6 JF - The British journal of dermatology JO - Br. J. Dermatol. VL - 153 IS - 5 N2 - BACKGROUND AND OBJECTIVES: The excimer laser delivers high energy monochromatic ultraviolet (UV) B at 308 nm. Advantages over conventional UV sources include targeting of lesional skin, reducing cumulative dose and inducing faster clearance. Studies of the pulsed dye laser (PDL) in psoriasis report between 57% and 82% response rates; remission may extend to 15 months. To our knowledge, this is the first study assessing both excimer and PDL in psoriasis. METHODS: We conducted a within-patient controlled prospective trial of treatment of localized plaque psoriasis. Twenty-two adult patients, mean Psoriasis Area and Severity Index 7.1, were recruited. Fifteen patients completed the full treatment, of which 13 were followed up to 1 year. Two selected plaques were treated with excimer twice weekly and V Beam PDL, pretreated with salicylic acid (SA), every 4 weeks, respectively. Two additional plaques, treated with SA alone or untreated, served as controls. The primary outcome measures were: (i) changes in plaque-modified Psoriasis Activity and Severity Index (PSI) scores from baseline to end of treatment; (ii) clinical response to treatment (CR(T)), assessed by serial photographs; (iii) percentage of plaques clear at the end of treatment; and (iv) percentage of plaques clear at 1-year follow-up. The secondary outcome measures were: (i) number of laser treatments to clearance; (ii) time to relapse; (iii) frequency of side-effects; and (iv) qualitative observations with SIAscope. RESULTS: The mean improvement in PSI was 4.7 (SD 2.1) with excimer and 2.7 (SD 2.4) with PDL. PSI improvement was significantly greater in excimer than PDL (P = 0.003) or both control plaques (P < 0.001). CR(T) indicated 13 patients responded best with excimer, two patients best with PDL, and in seven patients there was no difference between the two lasers. CR(T) was significantly greater for excimer than PDL (P = 0.003) or both controls (P < 0.001). CR(T) was also significantly greater for PDL than SA alone (P = 0.004) or untreated control (P =0.002). Nine (41%) patients cleared with excimer, after mean 8.7, median 10 weeks treatment. Seven of these nine patients were followed up to 1 year; four remained clear, two relapsed at 1 month, and one at 6 months. Six (27%) patients cleared with PDL, after mean 3.3, median four treatments. All six patients were followed up to 1 year; four remained clear, one relapsed at 4 months and one at 9 months. Despite common side-effects including blistering and hyperpigmentation, patient satisfaction was high. Serial images obtained with the SIAscope during treatment indicated different mechanisms of action of the two lasers. CONCLUSIONS: Excimer and V Beam PDL are useful treatments for plaque psoriasis. Although the excimer appears to be on average more efficacious, a subset of patients may respond better to PDL. Long-term remission is achievable with both lasers. SN - 0007-0963 UR - https://www.unboundmedicine.com/medline/citation/16225606/Controlled_study_of_excimer_and_pulsed_dye_lasers_in_the_treatment_of_psoriasis_ L2 - https://doi.org/10.1111/j.1365-2133.2005.06827.x DB - PRIME DP - Unbound Medicine ER -