1
|
Jaalouk D, Algarin YA, Pulumati A, Humeda J, Nouri K. Lasers for the treatment of nail psoriasis: a systematic review. Int J Dermatol 2024. [PMID: 38858829 DOI: 10.1111/ijd.17304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 06/12/2024]
Abstract
This systematic review assesses the evidence concerning laser treatments for nail psoriasis (NP), a prevalent condition among individuals with cutaneous psoriasis that notably affects their quality of life. Traditional treatments have limitations in terms of drug delivery and poor patient adherence, leading to interest in laser therapies for their targeted approach, extended treatment intervals, and the potential to enhance topical medication effectiveness. The MEDLINE, Embase, Web of Science, and Cochrane Library databases were searched. English-language randomized and non-randomized controlled trials with full-text availability were included. Data on the laser type, treatment protocol, Nail Psoriasis Severity Index (NAPSI) outcomes, and adverse events were extracted, and nail bed and matrix features and patient satisfaction were assessed. The primary effect measure was a percentage reduction in NAPSI scores from baseline. Nineteen studies involving the pulse dye laser (PDL), long-pulsed neodymium:yttrium aluminum garnet (Nd:YAG) laser and fractional carbon dioxide laser (FCL) were identified. Lasers, particularly those used in conjunction with topical agents, have shown favorable results. PDL effectively lowered NAPSI scores, and the Nd:YAG laser had comparable effectiveness but more discomfort. FCL also shows promise, particularly for topical drug delivery. PDL and Nd:YAG laser treatment were more effective at reducing nail bed features, whereas FCL was effective at reducing both nail bed and matrix features. Overall, lasers are promising treatment alternatives for NP, with similar NAPSI outcomes to topical therapies and intralesional injections.
Collapse
Affiliation(s)
- Dana Jaalouk
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Yanci A Algarin
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
- Eastern Virginia Medical School, Norfolk, VA, USA
| | - Anika Pulumati
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jasmine Humeda
- Division of Dermatology, University of Louisville, Louisville, KY, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
2
|
Ortner VK, Kilov K, Mondragón AC, Fredman G, Omland SH, Manole I, Laugesen CAP, Havsager S, Johansen B, Duvold T, Isberg AP, Andersen AD, Zibert JR, Hædersdal M. Mobile health technologies in an interventional hybrid study on actinic keratosis: Results from an early phase randomized controlled trial investigating the safety and efficacy of a cytosolic phospholipase A2 inhibitor gel in photodamaged skin. Exp Dermatol 2024; 33:e15068. [PMID: 38610094 DOI: 10.1111/exd.15068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
Hybrid trials are a new trend in dermatological research that leverage mobile health technologies to decentralize a subset of clinical trial elements and thereby reduce the number of in-clinic visits. In a Phase I/IIa randomized controlled hybrid trial, the safety and efficacy of an anti-proliferative and anti-inflammatory drug inhibiting cytosolic phospholipase A2 (AVX001) was tested using 1%, 3% or vehicle gel in 60 patients with actinic keratosis (AK) and assessed in-clinic as well as remotely. Over the course of 12 weeks, patients were assessed in-clinic at baseline, end of treatment (EOT) and end of study (EOS), as well as 9 times remotely on a weekly to biweekly basis. Safety outcomes comprising local skin reactions (LSR; 0-5), adverse events (AE) and cosmesis, were graded in-clinic and remotely using patient-obtained smartphone photographs (PSPs) and questionnaires; efficacy was assessed in-clinic based on clinically visible clearance of AK target area of >50%. A total of 55 participants (91.7%) completed the treatment course. The average submission rate of PSPs was high (≥85%), of which 93% were of sufficient quality. No serious AE were reported and only two experienced temporary LSR >2 (scale 0-4) and cosmesis remained stable throughout the study. Based on the mild AE and LSR profile, daily application of AVX001 gel for 1 month appears safe, tolerable, and cosmetically acceptable for use in patients with AK. At EOT, AVX001 achieved a subtle treatment response with clearance of AK target area of >50% in 18% of patients. Remote and in-clinic assessments of LSRs were in high agreement, suggesting that the use of mobile health technologies in early-phase hybrid studies of AK does not compromise patient safety.
Collapse
Affiliation(s)
- Vinzent Kevin Ortner
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | | | - Gabriella Fredman
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Silje Haukali Omland
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ionela Manole
- Studies&Me A/S, Copenhagen, Denmark
- 2nd Department of Dermatology, Colentina Clinical Hospital, Bucharest, Romania
| | | | | | - Berit Johansen
- Coegin Pharma AB, Lund, Sweden
- Department of Biology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | | | | | - John R Zibert
- Studies&Me A/S, Copenhagen, Denmark
- Coegin Pharma AB, Lund, Sweden
| | - Merete Hædersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Tartaglia J, Piaserico S, Naldi L, Sechi A. Ablative CO 2-Assisted Laser for Topical Drug Delivery in Nail Psoriasis: A Systematic Review. Skin Appendage Disord 2024; 10:156-166. [PMID: 38572191 PMCID: PMC10987169 DOI: 10.1159/000535022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/01/2023] [Indexed: 04/05/2024] Open
Abstract
Background Nail psoriasis poses challenges for effective treatment, and topical drug delivery through the nail plate is limited. A novel approach to address this challenge involves the use of ablative fractional laser as a pretreatment strategy to enhance topical drug delivery for nail psoriasis. Summary This systematic review, conducted in accordance with PRISMA guidelines, involved an extensive literature search across PubMed/MEDLINE, EMBASE, and the Cochrane Library up to July 2023. The primary focus was on exploring studies that investigated the application of ablative laser technology to augment drug delivery for nail psoriasis. Key Messages (1) The review included seven randomized controlled trials, all examining the combination of fractional CO2 laser with topical treatments. These trials demonstrated varying degrees of improvement in nail psoriasis. (2) Patients undergoing laser treatment reported experiencing moderate levels of pain, effectively managed through the application of topical anesthesia. (3) Commonly observed side effects included erythema, swelling, and crusting, with the Koebner phenomenon being a rare occurrence. (4) Notably, patient satisfaction levels with the combined approach of laser and topical treatments were consistently high. In conclusion, the utilization of ablative CO2-assisted laser pretreatment, when used in conjunction with topical therapy, appears to be both effective and well-tolerated for the treatment of nail psoriasis. However, the establishment of optimal parameters and treatment intervals for fractional laser therapy remains an area for further research. Standardized studies are imperative to identify the most effective strategy for enhancing topical drug delivery in the context of nail psoriasis treatment.
Collapse
Affiliation(s)
- Jacopo Tartaglia
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Stefano Piaserico
- Dermatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Luigi Naldi
- UOC Dermatologia, Ospedale San Bortolo, Vicenza, Italy
| | - Andrea Sechi
- UOC Dermatologia, Ospedale San Bortolo, Vicenza, Italy
| |
Collapse
|
4
|
Abbas A, Amin S, Sanyi A, Mayo T, Elewski B. Calcipotriene/Betamethasone Dipropionate Foam as a Potential Safe and Effective Treatment of Nail Psoriasis. Skin Appendage Disord 2024; 10:34-36. [PMID: 38313566 PMCID: PMC10836930 DOI: 10.1159/000533994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/01/2023] [Indexed: 02/06/2024] Open
Abstract
Background Nail psoriasis is a common condition that affects quality of life in individuals with psoriasis and psoriatic arthritis. Topical treatments have been shown to be effective in treating nail bed disease but not as effective in treating nail matrix diseases, which often requires intralesional corticosteroids. Objectives The objective of this open-label study was to evaluate the efficacy of combination calcipotriol/betamethasone dipropionate foam as a treatment for nail psoriasis including nail matrix disease. Method We report three patients with moderate to severe nail psoriasis with involvement of all ten fingernails who applied study foam nightly for 6 months. Nails were assessed using the NAPSI score evaluating both nail bed and nail matrix disease. Results NAPSI score improved including nail matrix disease in the majority of nails. No skin irritation or unexpected adverse events occurred. Conclusions We conclude this foam combination product could be an effective and safe treatment for fingernail psoriasis and may provide better nail matrix penetration as evidenced by improvement in nail matrix score. Further studies are needed for additional evaluation.
Collapse
Affiliation(s)
- Alia Abbas
- Department of Dermatology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Sima Amin
- Department of Dermatology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Adaugo Sanyi
- Department of Dermatology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Tiffany Mayo
- Department of Dermatology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Boni Elewski
- Department of Dermatology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| |
Collapse
|
5
|
Konisky H, Klinger R, Coe L, Jaller JA, Cohen JL, Kobets K. A focused review on laser- and energy-assisted drug delivery for nail disorders. Lasers Med Sci 2024; 39:39. [PMID: 38240827 PMCID: PMC10799127 DOI: 10.1007/s10103-024-03992-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
The purpose of this review is to consolidate and summarize laser-assisted drug delivery (LADD) for nail diseases, particularly onychomycosis and psoriasis. A PubMed search was conducted in June 2023 using search terms (1) "laser assisted drug delivery" AND "nail," (2) "laser" AND "nail," and (3) "nail disorder" AND "laser treatment." References of papers were also reviewed, yielding 15 papers for this review. Fractional ablative CO2 laser (FACL) and Er:YAG laser can be used for LADD of topical medications such as amorolfine, terbinafine, and tioconazole to treat onychomycosis. A fungal culture should be performed to determine the type of dermatophyte, which will help determine which topical will be most effective. Laser settings varied between studies, but overall LADD tended to be more effective than topical treatments alone. Laser-assisted photodynamic therapy (PDT) was also found to be effective in treating onychomycosis. For psoriatic nails, LADD was used to deliver calcipotriol-betamethasone dipropionate foam, tazarotene, triamcinolone, or methotrexate into the nail. Again, LADD was found to be significantly more effective than topical treatment alone. FACL was the only laser noted for use for LADD in both diseases. Laser-assisted drug delivery for nail disease is a newer approach for onychomycosis and nail psoriasis with several benefits and drawbacks. Dermatologists should discuss the option of LADD with their patients who have recalcitrant onychomycosis or nail psoriasis.
Collapse
Affiliation(s)
- Hailey Konisky
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Ave, Bronx, NY, 10461, USA.
| | - Raquel Klinger
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Lesley Coe
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Jose A Jaller
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Joel L Cohen
- AboutSkin Dermatology and DermSurgery, Greenwood Village, CO, USA
| | - Kseniya Kobets
- Albert Einstein College of Medicine, Montefiore Medical Center, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| |
Collapse
|