Hassan Moftah Nayera, H Abbas Helmy Wafaa, Mohamed Elbakry Asmaa, Mohammed Gamal-Edeen Alzahraa, Al-Sayed Al-Kady Nissreen
Department of Dermatology and Venereology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.
Department of Pathology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.
Arch Dermatol Res. 2024 Dec 21;317(1):153. doi: 10.1007/s00403-024-03636-3.
Methotrexate injections intralesionally as a treatment for psoriatic nails proved to be effective in large-scale studies as well as individual case reports, but the process is painful and time-consuming. The objective of this study was to compare the efficacy and safety of combined fractional CO2 laser (Fr. CO2) 10,600 nm and methotrexate gel versus methotrexate 1% gel alone in treatment of nail psoriasis. In this intra-patient randomized comparative study, 36 patients were treated for finger nail psoriasis. One hand was randomly selected to be treated with a Fr. CO2 laser at 10,600 nm in monthly sessions in addition to the daily application of methotrexate 1% gel for 4 months (Fr. CO2 group). The other hand was treated with daily application of methotrexate 1% gel alone for the same period (non-laser group). Evaluation was done at the end of 4 months treatment and 3 months after treatment both clinically and dermoscopically. In addition, histopathological evaluation was done 3 months after treatment. At the end of treatment, both hands experienced significant improvement in total nail psoriasis severity index (NAPSI) (P = 0.001,for each hand) with no significant difference between both (p = 0.593). Three months after treatment, the improvement in NAPSI score in Fr. CO2 group was significantly greater than that in non-laser group (p = 0.001). The dermoscopic evaluation showed significant improvement in both hands at the end of treatment and 3 months after treatment. Regarding microscopic examination of nail psoriatic, the mean value of nail plate thickness and subungual thickness significantly decreased, three months after treatment in both groups with significant higher improvement in Fr. CO2 group compared with non-laser group (p = 0.011, 0.000), respectively. Nail plate serous lake, subungual serous lake, parakeratosis and Munro's abscess significantly improved 3 months after treatment. with no significant difference between both sides. Although minimal pain during the session was in 20% and erythema in 37.1% of patients that last less than 24 h were noticed in Fr. CO2 group, patient satisfaction was still higher among patients in this group (p = 0.02). It is concluded that topical methotrexate 1% gel is an effective topical treatment for nail psoriasis. However, Fr. CO2 laser-assisted delivery of methotrexate 1% gel is superior to unassisted methotrexate 1% gel application.
在大规模研究以及个别病例报告中，甲氨蝶呤皮损内注射治疗银屑病甲已被证明是有效的，但该过程痛苦且耗时。本研究的目的是比较联合分次二氧化碳激光（Fr. CO2）10600纳米与甲氨蝶呤凝胶和单纯1%甲氨蝶呤凝胶治疗甲银屑病的疗效和安全性。在这项患者内随机对照研究中，36例患者接受了手指甲银屑病治疗。随机选择一只手，除每天涂抹1%甲氨蝶呤凝胶持续4个月外，每月接受一次10600纳米的Fr. CO2激光治疗（Fr. CO2组）。另一只手同期仅每天涂抹1%甲氨蝶呤凝胶（非激光组）。在治疗4个月结束时和治疗后3个月进行临床和皮肤镜评估。此外，在治疗后3个月进行组织病理学评估。治疗结束时，双手的甲银屑病严重程度指数（NAPSI）均有显著改善（每只手P = 0.001），两者之间无显著差异（P = 0.593）。治疗后3个月，Fr. CO2组的NAPSI评分改善明显大于非激光组（P = 0.001）。皮肤镜评估显示，治疗结束时和治疗后3个月双手均有显著改善。关于银屑病甲的显微镜检查，两组治疗3个月后甲板厚度和甲下厚度的平均值均显著降低，Fr. CO2组的改善明显高于非激光组（分别为P = 0.011，0.000）。治疗3个月后，甲板浆液湖、甲下浆液湖、角化不全和门罗脓肿均有显著改善。两侧之间无显著差异。尽管Fr. CO2组有20%的患者在治疗过程中出现轻微疼痛，37.1%的患者出现持续时间少于24小时的红斑，但该组患者的满意度仍然较高（P = 0.02）。结论是，1%甲氨蝶呤凝胶局部治疗甲银屑病是一种有效的局部治疗方法。然而，Fr. CO2激光辅助递送1%甲氨蝶呤凝胶优于单纯涂抹1%甲氨蝶呤凝胶。
