Kołt-Kamińska Marta, Żychowska Magdalena, Reich Adam
Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland.
Dermatol Ther (Heidelb). 2021 Apr;11(2):449-464. doi: 10.1007/s13555-021-00486-z. Epub 2021 Jan 19.
About 70-80% of patients with psoriasis suffer from mild disease, and new modalities of topical treatment are urgently needed. This study aims to evaluate the effectiveness of 650-microsecond 1064-nm Nd:YAG laser in the therapy of psoriatic plaques and assess the utility of dermoscopy in predicting treatment response.
Ten patients (mean age 37.4 ± 16.2 years) with stable plaque-type psoriasis were enrolled. The microsecond Nd:YAG laser treatment was applied to representative plaques on day 0, 7, 14, and 21. Clinical and dermoscopic photographs were performed at each session and follow-up visit (day 28). The disease severity was assessed using modified Psoriasis Area and Severity Index (mPASI) and Investigator Global Assessment (IGA). Patients were asked to rate the intensity of subjective symptoms, tolerability, and final outcome of the treatment.
Significant improvement of all mPASI components was observed, although the maximal mean reduction of total mPASI was only 30.3%. At baseline, three patients were assessed as "moderate" and seven as "mild" according to IGA, while on day 28, eight patients were scored as "mild" and two as "almost clear." Complete resolution of itching was achieved in all patients. Local adverse reactions were also observed, which resulted in moderate tolerance of treatment in four patients. Three participants reported marked improvement on day 28, although 30% of patients observed no benefit. All subjects with dotted vessels, linear vessels, or hemorrhagic spots under dermoscopy at baseline reported some improvement after laser therapy. Three out of six patients with globular vessels were unresponsive to Nd:YAG laser.
Microsecond Nd:YAG laser treatment may provide some improvement of psoriatic plaques, but its routine applicability seems to be limited due to ambiguous efficacy and local adverse reactions. Dermoscopy may be useful in identifying patients who will benefit from the procedure.
约70 - 80%的银屑病患者患有轻度疾病，因此迫切需要新的局部治疗方法。本研究旨在评估650微秒1064纳米钕钇铝石榴石激光治疗银屑病斑块的有效性，并评估皮肤镜检查在预测治疗反应中的作用。
纳入10例（平均年龄37.4±16.2岁）稳定期斑块型银屑病患者。在第0、7、14和21天，对代表性斑块进行微秒钕钇铝石榴石激光治疗。每次治疗及随访（第28天）时拍摄临床和皮肤镜照片。使用改良银屑病面积和严重程度指数（mPASI）及研究者整体评估（IGA）评估疾病严重程度。要求患者对主观症状的强度、耐受性和治疗的最终结果进行评分。
观察到所有mPASI组分均有显著改善，尽管总mPASI的最大平均降低仅为30.3%。基线时，根据IGA评估，3例患者为“中度”，7例为“轻度”，而在第28天，8例患者评分为“轻度”，2例为“几乎清除”。所有患者的瘙痒均完全缓解。还观察到局部不良反应，导致4例患者对治疗的耐受性为中度。3名参与者在第28天报告有明显改善，尽管30%的患者未观察到益处。基线时皮肤镜检查发现有点状血管、线状血管或出血点的所有受试者在激光治疗后均有一定改善。6例有球状血管的患者中有3例对钕钇铝石榴石激光无反应。
微秒钕钇铝石榴石激光治疗可能会使银屑病斑块有所改善，但由于疗效不明确和局部不良反应，其常规适用性似乎有限。皮肤镜检查可能有助于识别将从该治疗中获益的患者。
