The combined analysis of these studies showed that $64 of patients with palmoplantar pustular psoriasis experienced an improvement of at least 70% at the end of treatment. Psoriasis is a chronic, inflammatory disease that primarily manifests with cutaneous findings and affects ~3% of the American population.4 The current understanding of the pathogenesis and pathophysiology of psoriasis is continuing to evolve, but the majority of knowledge surrounds the most classical variant, psoriasis vulgaris. Mehraban S, Feily A. ability to treat mi ld, moderate and eve n severe but localised. An optimal therapeutic dose protocol with excimer laser for the treatment of plaque psoriasis yielded more effective dosing in fewer treatment sessions, … Several features of https://www-03.ibm.com/press/us/en/pressrelease/39829, Creative Commons Attribution - Non Commercial (unported, v3.0) License. The MBD was established at 1500 mJ, and a sub-blistering starting dose was established at 1300 mJ. This is a discussion that should be had with patients and clinicians before treatment. 2010;62:114–135. J Drugs Dermatol. 2010 Jan;21(1):54-60. doi: 10.3109/09546630903203756. Single administration of lesion-limited high-dose (TURBO) UVB using the excimer laser: clinical clearing in association with apoptosis of epidermal and dermal T cell subsets in psoriasis. Phototoxicity in the form of erythema and blistering occurred in all patients and was noted to be more prominent around the nape of the neck and on the ears.38, The excimer laser can also be an excellent option for nail psoriasis, which can often be difficult to treat. NLM  |  The Lancet. Am J Ophthalmol. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms. Photodermatol Photoimmunol Photomed. The laser was an XTRAC XeCl excimer (PhotoMedex, Radnor, Pa) with output consisting of monochromatic 308-nm light with a pulse width of 30 ns and a fiberoptic delivery system connected to The three main protocols that were identified were the MED protocol, the Induration protocol, and the MBD protocol. There have been five prospective studies investigating the use of excimer laser in the treatment of palmoplantar pustular psoriasis. Dong J, He Y, Zhang X, Wang Y, Tian Y, Wang J. Treatment of inverse psoriasis with the 308 nm excimer laser. Dermatol Surg. 308-nm excimer laser for the treatment of psoriasis: induration-based dosimetry. J Drugs Dermatol. Photodermatol Photoimmunol Photomed. Photodermatol Photoimmunol Photomed. Methods: Feldman SR, Mellen BG, Housman TS, et al. 308-nm excimer laser for the treatment of psoriasis: a dose-response study. Supraerythemogenic excimer laser in combination with clobetasol spray and calcitriol ointment for the treatment of generalized plaque psoriasis: Interim results of an open label pilot study. Dermatol Surg. As its usage as a targeted monotherapy increases, future trials should consider evaluating and modifying these parameters to determine the most optimal management of localized psoriasis. Arch Dermatol. Back to Journals » Psoriasis: Targets and Therapy » Volume 6, Authors Abrouk M, Levin E, Brodsky M, Gandy JR, Nakamura M, Zhu TH, Farahnik B, Koo J, Bhutani T, Published 12 December 2016 Photodermatol Photoimmunol Photomed. Of the 21 patients who completed the protocol, 76% achieved at least PASI-75 by week 12. Park KK, Swan J, Koo J. Pilot evaluation of supra-erythemogenic phototherapy with excimer laser in the treatment of patients with moderate to severe plaque psoriasis. Taneja A, Trehan M, Taylor CR. 1984;4:201–206. 308-nm excimer laser for the treatment of scalp psoriasis. Mafong EA, Friedman PM, Kauvar AN, et al. In their 12-week study, patients received twice weekly treatment with the 308 nm excimer laser combined with clobetasol propionate twice daily for a month followed by calcitriol ointment twice daily for the subsequent month. Keywords: excimer, laser, 308 nm, psoriasis, safety, efficacy. J Dermatolog Treat. The initiation of psoriasis begins with an amalgamation between environment and genetic factors. 2015;21. Exp Ther Med. Goldberg DJ, Chwalek J, Hussain M. 308-nm excimer laser treatment of palmoplantar psoriasis. Treatment for palmoplantar pustular psoriasis: systematic literature review, evidence-based recommendations and expert opinion. Please enable it to take advantage of the complete set of features! Lasers Surg Med. Glossop ND, Jackson RW, Koort HJ, Reed SC, Randle JA. A tapering of laser treatments may be beneficial in maintaining the level of plaque clearance obtained from biweekly laser treatments. Trehan M, Taylor CR. Javascript is currently disabled in your browser. Manual separation of the hair was used to provide access, and starting doses ranged from 300 to 1000 mJ depending on Fitzpatrick skin type. Excimer laser for psoriasis treatment: A case report and short review. Excimer Use for OLP. This aspect potentially reduces the patient’s skin cancer risk and can feasibly improve patient compliance.1 Furthermore, the excimer laser has the ability to target difficult to reach areas and administer site-specific dosing.16 Also, it can operate with the ability to change the energy level (in millijoules) delivered during treatment. The right-hand nails were treated with excimer laser twice weekly for 12 weeks and the left-hand nails were treated with PDL once every 4 weeks for a total of 12 weeks. Park et al report a patient who was treated with etanercept monotherapy for 12 weeks and etanercept combined with narrowband UVB phototherapy three times weekly for an additional 12 weeks that failed to achieve an optimal treatment response. Wong JW, Nguyen TV, Bhutani T, Koo JY. Cytokines produced from innate immune cells activate myeloid dendritic cells, which in turn present antigens and secrete mediators leading to Th17 and Th1 differentiation. Nonetheless, even with a sub-blistering dose, patients tolerated the treatment very well and in clinical experience even the blistering and erythema are often well tolerated compared to their untreated psoriasis. Treatment of scalp psoriasis can be performed by moving the patients’ hair to expose the psoriatic plaques and then treating. Abbreviation: MED, minimal erythema dose. Register your specific details and specific drugs of interest and we will match the information you provide to articles from our extensive database and email PDF copies to you promptly. 2012;18:2. Resolution in these patients generally requires more treatments than non-intertriginous psoriatic lesions. Over the years the excimer laser has evolved in its clinical usage, and appropriately, so have the treatment protocols that are used in clinical practice. However, if patients are more concerned with side effects of blistering, erythema, and tenderness, then the MED or Induration protocols may be more advantageous. J Drugs Dermatol. Each of these protocols make use of different features of the patients’ psoriasis to help determine the optimal dosimetry when utilizing the excimer laser. Although the excimer laser is not a first-line treatment, it remains an excellent treatment option for psoriasis patients and has been demonstrated to be an effective treatment with little to no side effects. Kemeny L, Bonis B, Dobozy A, Bor Z, Szabó G, Ignácz F. 308-nm excimer laser therapy for psoriasis. Bulk reprints for the pharmaceutical industry. Trokel SL, Srinivasan R, Braren B. Excimer laser surgery of the cornea. Different approaches regarding dose fluency, number of treatments, and maintenance have been utilized, and there is yet to be a consensus on standard protocol. We offer real benefits to our authors, including fast-track processing of papers. In the recent past, several groups have focused on larger scale studies that demonstrate the safety and use of the laser for individuals with mild to moderate localized plaque psoriasis. Because the laser light never touches the surrounding skin, it reduces the risk of UV radiation exposure. The excimer laser has been used successfully in patients with AA. Sevrain M, Richard MA, Barnetche T, et al. 2005;22:161–165. 2020 Jul;20(1):52-55. doi: 10.3892/etm.2020.8529. Finally, alopecia areata can be treated with the 308nm excimer laser. Even psoriasis that has been refractory to systemic treatments have been demonstrated to show improvement with the excimer laser. 2019 Summer;10(3):251-253. doi: 10.15171/jlms.2019.40. J Am Acad Dermatol. Background: The excimer laser has been adopted by other medical disciplines such as cardiology, dentistry, and orthopedics.12–14. Excimer lasers are used to treat mild-to-moderate psoriasis. Future studies pertaining to the safety of the 308 nm laser in the treatment of psoriasis will presumably include continued modification of the treatment protocol to reduce the number of treatments needed for plaque resolution, while still resulting in longer periods of plaque remission. This study suggests that nine sessions on average equating to a mean cumulative dose of 4.45 J UVB are adequate for complete plaque resolution. •  Top, © Copyright 2021  •  Dove Press Ltd   excimer laser. J Dermatolog Treat. Conclusion: Although the excimer laser is not a first-line treatment, it remains an excellent treatment option for psoriasis patients and has been demonstrated to be an effective treatment with … 2014 Sep 15;7(9):2844-50. eCollection 2014. The XTRAC laser is a type of excimer laser that uses ultraviolet light to treat many forms of psoriasis. J Dermatolog Treat. You can learn about our use of cookies by reading our Privacy Policy. IBM News Room. 2006;22:181–183. The treatment protocol used in that study involved stepwise dose increments similar to conventional phototherapy. Dove Medical Press is a member of the OAI. It means that the treatment will not work well for psoriasis cases that affect large parts of the body. Few adverse reactions have been reported, and they are consistent with adverse reactions associated with other forms of phototherapy including erythema, blistering, hyperpigmentation, and hypopigmentation (Figure 3). In addition to psoriasis, a vast number of other cutaneous diseases can also be treated with the excimer laser. J Am Acad Dermatol. The three main protocols used for the treatment of psoriasis include: the minimal erythema dose (MED) protocol, the induration protocol, and the newer minimal blistering dose (MBD) protocol.30, The MED is established by first testing healthy, non-psoriatic skin and determining the minimal dose (millijoules) that causes a well-demarcated, minimally erythematous pink macule.33 Typically, with this method, the patient the will require two initial visits to calibrate the MED, with a total of 12 treatments sessions thereafter to reach PASI-75.18 Information pertaining to exact treatment dosages in terms of millijoules is limited, as studies only report cumulative doses at the end of the patient treatment course. J Dermatol Treat. Loughran M. President Obama honors IBM scientists with National Medal Of Technology And Innovation for Breakthrough That Enabled LASIK Surgery. •  Associations & Partners   To characterize treatment parameters for 308 nm excimer laser phototherapy. Clipboard, Search History, and several other advanced features are temporarily unavailable. Pediatr Dermatol. Physica-Verlag, Springer: Heidelberg. J Eur Acad Dermatol. At his 1-week follow up, the patient was noted to have achieved PASI-75.17, Although there have been no studies formally evaluating patient acceptability of the excimer laser treatment, the previously mentioned safety profile for excimer laser treatment of psoriasis makes it a generally well-tolerated treatment. There were a variety of treatment protocols that were identified for the treatment of psoriasis with the excimer laser. 2004;34:136–140. EXCIMER 308 Monochromatic UVB light therapy for Psoriasis and Vitiligo skin diseases. 2012;28:184–190. Linsker R, Srinivasan R, Wynne JJ, Alonso DR. Far-ultraviolet laser ablation of atherosclerotic lesions. (Although less commonly used, the proper term for such is an exciplex laser.). 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