Randomized, Investigator-Blinded Study to Compare the Efficacy and Tolerance of a 650-microsecond, 1064-nm YAG Laser to a 308-nm Excimer Laser for the Treatment of Mild to Moderate Psoriasis Vulgaris

February 2020 | Volume 19 | Issue 2 | Original Article | 176 | Copyright © February 2020


Published online January 9, 2020

Mark S. Nestor , Daniel Fischer , David Arnold

aCenter for Clinical and Cosmetic Research, Aventura, FL bDepartment of Dermatology and Cutaneous Surgery, Department of Surgery, Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, FL

Abstract
BACKGROUND: Phototherapy is a safe and effective modality for the treatment of mild to moderate psoriasis.

OBJECTIVES: To compare the efficacy and safety of the 650-microsecond, 1064-nm pulsed YAG laser with the excimer laser for the treatment of mild to moderate psoriasis vulgaris of the arms and legs.

METHODS: Eligible subjects (n=15) aged 54.3 ± 11.7 years enrolled in a randomized, investigator-blinded study. Psoriatic plaques on one side of the body were treated with the 650-microsecond laser and plaques on the other side were treated with the 308-nm excimer laser. Subjects made up to 15 visits, twice weekly, or fewer if full clearance was achieved. Efficacy and tolerance were evaluated by the mPASI scores and local skin reactions, respectively.

RESULTS: Both devices showed efficacy in treating psoriatic plaques. Differences between the two devices were not significant for redness, thickness, scaliness, mPASI scores for arms and legs, and overall mPASI scores for the treated psoriatic plaques on each side of the body. The investigator-assessed scores for erosion/ulceration, vesicles, erythema, scaling, edema, and atrophy were low and identical for both sides of the body.

CONCLUSION: The efficacy and tolerance of the 650-microsecond laser is equivalent to that of the excimer laser for the treatment of mild to moderate psoriasis vulgaris of the arms and legs.

J Drugs Dermatol. 2020;19(2)176-183 doi:10.36849/JDD.2020.4769

INTRODUCTION

Current options for the treatment of psoriasis include systemic and topical modalities. Systemic therapies include immune inhibitors, immune modulators and, for moderate to severe disease, biological agents.1 Primarily, for mild to moderate psoriasis, topical treatments comprise ointments, medicated bath with diastase or herbal extracts, and phototherapy. Phototherapy is safe, effective, and does not incur the side effects of systemic medications.2

The 308-nm excimer laser is considered first-line phototherapy for topical plaque psoriasis.2 The efficacy and safety of this laser has been extensively evaluated for the treatment of psoriasis.3-9 The advantage of the excimer laser is its ability to treat psoriatic lesions with high doses of monochromatic radiation while sparing unaffected skin.2 Three protocols have been developed to optimize treatment: the minimal erythema dose, the induration, and the minimal blistering dose.7

 A novel 650-microsecond 1064-nm Nd: YAG laser was introduced in 2009 by Khatri and colleagues who used the laser to remove unwanted hair.10 Since then, other investigators have used the 650-microsecond laser to treat skin of color,11,12 onychomycosis,13 facial telangiectasias,14 and acne.15 The advantage of the 650-microsecond laser is that treatment does not require cooling or anesthesia because the pulse duration is shorter than or equal to the thermal relaxation time of the therapeutic target. This feature minimizes scarring, pigmentary changes, thermal damage to surrounding tissues, and discomfort during or after treatment.15 The 650-microsecond laser has received FDA approval for the treatment of psoriasis.


The primary objective of this study was to compare the ability of the 650-microsecond, 1064-nm pulsed YAG laser (LightPod Neo®, Aerolase Corp., Tarrytown, NY) to clear psoriatic plaques with that of the 308-nm excimer laser (XTRAC Velocity 400®, PhotoMedex, Inc., Montgomeryville, PA). Plaques were located on the limbs of subjects with mild-to-moderate psoriasis vulgaris.