Efficacy of Fractional Carbon Dioxide Laser-Assisted Topical Corticosteroid Delivery versus Topical Corticosteroid Alone for The Treatment of Nail Psoriasis: A Randomized, Prospective Study
Keywords:
Fractional carbon dioxide laser, Topical corticosteroid, Nail psoriasisAbstract
The treatment of nail psoriasis was a difficult challenge in terms of treating the disease with unpredictable results. The clinical responses could be disappoint with a high relapse rate due to the poor penetrability of topical therapies through the nail plate. One of the options is to use a fractional carbon dioxide laser (FCO2 laser), which can create microchannels to enhance drug permeation and assist the transungual delivery of a topically applied drug. At present, no research has been conducted in Thailand to study the efficacy of FCO2 laser treatment for nail psoriasis. In this study, we aimed to evaluate the effectiveness and compare effectiveness as well as the satisfaction and side effects of FCO2 laser-assisted topical corticosteroid delivery versus topical corticosteroid alone for the treatment of nail psoriasis. This randomized prospective study was performed at Sakon Nakhon Hospital in December 2023 – May 2024, 24 patients with bilateral fingernail psoriasis randomly received 6 sessions of FCO2 laser at 2-week intervals plus topical corticosteroid (0.25% Desoximetasone lotion) twice daily for one hand, and topical corticosteroid only twice daily for 22 weeks on the other hand. The outcomes were evaluated by the Nail Psoriasis Severe Index (NAPSI) at 22 weeks compared to baseline.
The results: This research, total patients were 24 patients. There were male 75.0%, with average age was 53.5 years old. Patient’s regular application of medication was 100%. The nail matrix, nail bed, and total NAPSI were significantly improved at 22 weeks by the FCO2 laser plus 0.25% Desoximetasone lotion regimen (p-value<0.001, all items), while the nail matrix NAPSI only was significantly improved at 22 weeks by the 0.25% Desoximetasone lotion regimen (p-value=0.036). From a comparison between the 2 groups at 22 weeks, the FCO2 Laser plus 0.25% Desoximetasone lotion regimen showed more significant improvement in the nail matrix, nail bed and total NAPSI than the 0.25% Desoximetasone lotion regimen (p-value=0.03, p-value=0.03 and p-value=0.02, respectively). Regarding side effects, 20.8% of patients had mild pain during the application of the FCO2 laser, but the patients were well tolerated.
Conclusion: This is the first research in Thailand to study the application of the FCO2 laser for use in the treatment of nail psoriasis. The FCO2 laser-assisted delivery of topical corticosteroid is an effective and well-tolerated treatment option for the management of nail psoriasis. Patients can gain ready access to the FCO2 laser due to its prevalence in general hospitals as well as clinics. Therefore, the FCO2 laser is a good option for patients in the treatment of nail psoriasis.
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