A Comprehensive Evaluation of the Efficacy of Intense Pulsed Light and Neodymium-doped Yttrium Aluminum Garnet Laser Treatments in Nail Psoriasis
Keywords:
nail psoriasis, IPL, Nd:YAG laserAbstract
Introduction: Nail psoriasis significantly impairs quality of life and remains therapeutically challenging due to the limited efficacy of treatments.
Objectives: To compare the clinical efficacy and safety of Nd:YAG laser and intense pulsed light (IPL) therapy in nail psoriasis using total and modified NAPSI scores, clinical and dermatoscopic findings.
Methods: This retrospective study evaluated 101 nails from 14 patients treated with either IPL (N=66) or Nd:YAG laser (N=35). Treatments were administered every 4–6 weeks for 2–8 sessions. Nail psoriasis severity was assessed at baseline and at six months using NAPSI, mNAPSI, and dermatoscopic and clinical features.
Results: PL therapy significantly reduced matrix (3.48→1.94), nail bed (3.47→1.33), total NAPSI (6.95→3.27), and mNAPSI (9.21→3.92) scores (P<0.05). Nd:YAG laser treatment also resulted in significant improvements in matrix (3.54→2.20), nail bed (3.77→1.97), total NAPSI (7.31→4.17), and mNAPSI (8.83→5.23) scores (P<0.05). In our cohort, IPL appeared to have a more favorable impact on mNAPSI, pitting, salmon patches, subungual hyperkeratosis, and splinter hemorrhages, while Nd:YAG tended to provide greater improvement in leukonychia (P<0.05). No recurrence or adverse event was observed during the 12-month follow-up period.
Conclusions: Both IPL and Nd:YAG laser therapies are safe and effective options for nail psoriasis. IPL showed superior efficacy in nail bed involvement, whereas Nd:YAG may be preferred for leukonychia. Laser-based treatments are promising alternatives in refractory cases.
References
Canal-García E, Bosch-Amate X, Belinchón I, Puig L. Nail Psoriasis. Actas Dermosifiliogr. May 2022;113(5):481–490. DOI:10.1016/j.ad.2022.01.006
Ji C, Wang H, Bao C, et al. Challenge of Nail Psoriasis: An Update Review. Clin Rev Allergy Immunol. Dec 2021;61(3):377–402. DOI:10.1007/s12016-021-08896-9
Mease PJ. Measures of psoriatic arthritis: Tender and Swollen Joint Assessment, Psoriasis Area and Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI), Modified Nail Psoriasis Severity Index (mNAPSI), Mander/Newcastle Enthesitis Index (MEI), Leeds Enthesitis Index (LEI), Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht Ankylosing Spondylitis Enthesis Score (MASES), Leeds Dactylitis Index (LDI), Patient Global for Psoriatic Arthritis, Dermatology Life Quality Index (DLQI), Psoriatic Arthritis Quality of Life (PsAQOL), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Psoriatic Arthritis Response Criteria (PsARC), Psoriatic Arthritis Joint Activity Index (PsAJAI), Disease Activity in Psoriatic Arthritis (DAPSA), and Composite Psoriatic Disease Activity Index (CPDAI). Arthritis Care Res (Hoboken). Nov 2011;63 Suppl 11:S64–85. DOI:10.1002/acr.20577
Jaalouk D, Algarin YA, Pulumati A, Humeda J, Nouri K. Lasers for the treatment of nail psoriasis: a systematic review. Int J Dermatol. Nov 2024;63(11):1484–1494. DOI:10.1111/ijd.17304
Wiznia LE, Quatrano NA, Mu EW, Rieder EA. A Clinical Review of Laser and Light Therapy for Nail Psoriasis and Onychomycosis. Dermatol Surg. Feb 2017;43(2):161–172. DOI:10.1097/dss.0000000000000841
Heidemeyer K, Kulac M, Sechi A, Cazzaniga S, Naldi L. Lasers for the treatment of psoriasis: a systematic review. Expert Rev Clin Immunol. Jul–Dec 2023;19(7):717–744. DOI:10.1080/1744666x.2023.2205640
Hern S, Stanton AW, Mellor RH, Harland CC, Levick JR, Mortimer PS. In vivo quantification of the structural abnormalities in psoriatic microvessels before and after pulsed dye laser treatment. Br J Dermatol. Mar 2005;152(3):505–11. DOI:10.1111/j.1365-2133.2005.06435.x
Gratz BW, Resnick GF, Etcheverry MJ, Geng X, Stringer TP. Pulsed dye laser for nail psoriasis: A systematic review and meta-analysis. J Am Acad Dermatol. Feb 22 2025. DOI:10.1016/j.jaad.2024.12.051
Meesters AA, Pitassi LH, Campos V, Wolkerstorfer A, Dierickx CC. Transcutaneous laser treatment of leg veins. Lasers Med Sci. Mar 2014;29(2):481–92. DOI:10.1007/s10103-013-1483-2
Babilas P, Schreml S, Szeimies RM, Landthaler M. Intense pulsed light (IPL): a review. Lasers Surg Med. Feb 2010;42(2):93–104. DOI:10.1002/lsm.20877
Morsy EE, Mohamed R, Omar SI. Intense pulsed light versus pulsed dye laser in the treatment of nail psoriasis: Intra-patient left to right comparative controlled study. Indian J Dermatol Venereol Leprol. Nov–Dec 2024;90(6):713–721. DOI:10.25259/ijdvl_429_2023
Shaheen MA, Dakhli AO, Hassen SI. Comparison between the efficacy of Intense Pulsed Light (I.P.L.) versus Photo-Dynamic Therapy (P.D.T.) with methylene-blue in the treatment of psoriatic nails. Photodiagnosis Photodyn Ther. Mar 2023;41:103298. DOI:10.1016/j.pdpdt.2023.103298
Tawfik AA. Novel treatment of nail psoriasis using the intense pulsed light: a one-year follow-up study. Dermatol Surg. Jul 2014;40(7):763–8. doi:10.1111/dsu.0000000000000048
Khashaba SA, Gamil H, Salah R, Salah E. Efficacy of long-pulsed Nd-YAG laser in the treatment of nail psoriasis: a clinical and dermoscopic evaluation. J Dermatolog Treat. Jun 2021;32(4):446–452. DOI:10.1080/09546634.2019.1668908
Kartal SP, Canpolat F, Gonul M, Ergin C, Gencturk Z. Long-Pulsed Nd: YAG Laser Treatment for Nail Psoriasis. Dermatol Surg. Feb 2018;44(2):227–233. DOI:10.1097/dss.0000000000001294
Roter G, Szczerkowska-Dobosz A, Nowicki RJ. Treatment of nail psoriasis with pulsed dye laser versus combined pulsed dye and Nd:YAG lasers-An intrapatient left-to-right study. Lasers Surg Med. Jul 2022;54(5):688–692. DOI:10.1002/lsm.23537
Hesham Ali Elwan Y, Abdel Azim A, Starace M, Shawky Abd Elhafiz H. Nd:YAG Laser in the Treatment of Nail Psoriasis: Clinical and Dermoscopic Assessment. Dermatol Pract Concept. Mar 2021;11(2):e2021140. DOI:10.5826/dpc.1102a140
El-Basiony MAS, El-Komy MHM, Samy NA, et al. Long-pulsed nd: YAG laser treatment of nail psoriasis: clinical and ultrasonographic assessment. Arch Dermatol Res. Jun 8 2024;316(7):365. DOI:10.1007/s00403-024-03036-7
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