excimer laser psoriasis protocol

The initiation of psoriasis begins with an amalgamation between environment and genetic factors. Our clinic is equipped with Alma’s Excimerlaser which is best device of worldwide. 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. The authors report no conflicts of interest in this work. The use of excimer laser in psoriasis was first documented in 1997 by Bonis, et al., who described the superior effects of excimer over traditional NB-UVB phototherapy in a non-randomized, left to right comparison in six patients. Carrascosa JM, Soria X, Domingo H, Ferrandiz C. Treatment of inverse psoriasis with excimer therapy and tacrolimus ointment. Stamm, U. et al. Comparison of the efficacy and safety of the 308 nm excimer laser for the treatment of localized psoriasis in adults and in children: a pilot study. 2012;11:92–97. It was reported that there were no side effects experienced, and the patients’ hairline remained clear during the entire duration of follow up, which was 3 months after therapy was completed.36, In a comparative study involving 13 patients with treatment refractory scalp psoriasis, the excimer laser was used for treatment in conjunction with a hair blow-dryer to help move the hair and deliver optimum laser penetration. NIH Terminology and history. Psoriasis treatment with excimer laser has proven to be effective even in early studies with Feldman et al demonstrating 84% of patients achieving a 75% or better improvement after 10 or fewer treatments (Figures 1 and 2). 308 nm excimer laser phototherapy is efficacious in the treatment of localized psoriasis. By the nature of the excimer laser, it is not as practical for monotherapy use in patients with severe plaque psoriasis, as the treatment field and practical application of the laser would make treatment a very time consuming and difficult process. 2012;28:293–298. Self-control study of combination treatment of 308 nm excimer laser and calcipotriene ointment on stable psoriasis vulgaris. Over 5 million XTRAC treatments have been performed by leading dermatologists around the … 2004:3;522–525. 2020 Jul;20(1):52-55. doi: 10.3892/etm.2020.8529. This makes the excimer laser a viable treatment option for patients with palmoplantar pustular psoriasis.40,41, Another advantageous aspect of the excimer laser is that it can be used in combination with other treatment modalities, and these often have a synergistic effect. 2012 Apr;66(4):664-72. doi: 10.1016/j.jaad.2011.07.011. The most commonly observed side effects are erythema, blistering, hyperpigmentation, and hypopigmentation.32 These side effects are typically observed only at the sites of treatment, they do not occur in all treatments, and are often well tolerated by patients. THE XTRAC ® ADVANTAGE. In theory, this achieves the maximum possible dose that a plaque can sustain without blistering the skin. 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. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms. 2015;26:16–18. 2016 Dec 12;6:165-173. doi: 10.2147/PTT.S105047. 308 nm UVB excimer laser for psoriasis. Arch Dermatol. This is a discussion that should be had with patients and clinicians before treatment. 308 nm excimer laser in dermatology. [press release]. Even psoriasis that has been refractory to systemic treatments have been demonstrated to show improvement with the excimer laser. If someone has only a few isolated patches of psoriasis, excimer laser therapy can target their UVB treatment. Linsker R, Srinivasan R, Wynne JJ, Alonso DR. Far-ultraviolet laser ablation of atherosclerotic lesions. From editorial acceptance to publication. 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. Excimer laser therapy is an option for the treatment of localised vitiligo and moderately severe localised psoriasis and unresponsive to topical treatments. Excimer lasers are used to treat mild-to-moderate psoriasis. Clinical efficacy of a 308 nm excimer laser for treatment of psoriasis vulgaris. Treatment of plaque-type psoriasis with the 308 nm excimer laser in combination with dithranol or calcipotriol. 2015;26:45–48. Applications of the excimer laser: a review. 2010 Jan;21(1):54-60. doi: 10.3109/09546630903203756. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Would you like email updates of new search results? Over 15 weeks the difference in mean modified PASI scores between the excimer laser-treated site and the control site was statistically significant (P<0.001) with the excimer treatment group showing substantial improvement and clearance.37, In another study by Morison et al 35 patients with scalp psoriasis who had failed prior intensive topical therapy were treated with the excimer laser. Results: The search results were included if they contained information pertaining to excimer laser and psoriasis treatment and description of the safety, efficacy, and patient acceptability of the treatment. All patients improved, and 49% of the patients cleared completely. 2004 Apr;15(2):94-7. doi: 10.1080/09546630310021947. Initially used in the treatment of refractory moderate plaque psoriasis, the 308 nm excimer laser uses UVB light to induce apoptosis, break DNA strands and, ultimately, decrease T-lymphocyte proliferation. Seven prospective studies were found describing the excimer efficacy for psoriasis. 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. This Xe2 excimer laser emitted at 172 nm, and with this a new class of lasers were invented.8 The first applications of the excimer lasers were within various research laboratories, including Avco Everett Research Laboratory, Sandia Laboratories, the Northrop Research and Technology Center, and the United States Government’s Naval Research Laboratory.9, The initial application of the excimer laser in the medical field emerged in 1983 from the collaboration of Rangaswamy Srinivasan and the ophthalmic surgeon Stephen Trokel.10,11 This collaboration led to the development of LASIK surgery procedure, which has been performed over 28 million times worldwide as of 2009. The 308 nm excimer laser has the ability to treat mild, moderate and even severe but localised psoriasis plaques and plays an important role in the treatment management of psoriasis. 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. Mafong EA, Friedman PM, Kauvar AN, et al. The 308 nm excimer laser is a widely used device throughout the field of dermatology for many diseases, including psoriasis, vitiligo, hypopigmented disorders, alopecia areata, atopic dermatitis, and in many other dermatologic diseases such as cutaneous T-cell lymphoma, other lymphoproliferative disorders, granuloma annulare, Langerhans cell histiocytosis, lichen planus, and localized scleroderma.1,2 The term excimer is derived from “excited dimer,” which describes the mixture of the noble gas xenon and the halogen chloride gas (XeCl) that is utilized. •  Privacy Policy   Other conditions like lymphomatoid papulosis, granuloma annulare, Langerhans cell histiocytosis lichen planus, lichen planopilaris and localized scleroderma can also be treated with the excimer laser. J Cosmet Laser Ther. Treatment for palmoplantar pustular psoriasis: systematic literature review, evidence-based recommendations and expert opinion. Physica-Verlag, Springer: Heidelberg. In general, four main categories of cutaneous diseases can be currently treated with the 308 nm excimer laser: psoriatic lesions—which will be the focus of this review—apigmented and hypopigmented lesions, pruritic disorders, and follicular diseases. 2002;46:732–737. 2003;361:1197–1204. Dove Medical Press is part of Taylor & Francis Group, the Academic Publishing Division of Informa PLC The 308 nm excimer laser is an excellent option for the treatment of psoriasis and has been demonstrated to be effective in many different ways. Most excimer lasers are of the noble gas halide type, for which the term excimer is, strictly speaking, a misnomer. Excimer lasers aim a high intensity ultraviolet B (UVB) light dose of a very specific wavelength -- 308 nanometers -- directly at the psoriasis plaques. There were a variety of treatment protocols that were identified for the treatment of psoriasis with the excimer laser. The XTRAC laser is a type of excimer laser that uses ultraviolet light to treat many forms of psoriasis. Bonis et al were the first to study the use of the 308 nm XeCl excimer laser in the field of dermatology in 1997. https://www-03.ibm.com/press/us/en/pressrelease/39829, Creative Commons Attribution - Non Commercial (unported, v3.0) License. J Eur Acad Dermatol. Successful Use of the 308-nm Excimer Laser in Early Patch Stage Mycosis Fungoides. 2012;17:6–9. 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. Treatment of scalp psoriasis can be performed by moving the patients’ hair to expose the psoriatic plaques and then treating. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. Several topicals have been studied including dithranol ointment, flumetasone/salicylic acid ointment, calcipotriol ointment, clobetasol spray, and calcitriol ointment.27–30 In one study by Rogalski et al, addition of dithranol ointment to the excimer laser protocol resulted in a reduced Psoriasis Area and Severity Index (PASI) score.27 Furthermore, use of flumetasone/salicylic acid ointment resulted in a lower cumulative UVB dose, as well as plaque improvement. Treatment of inverse psoriasis with the 308 nm excimer laser. Efficacy of the 308-nm excimer laser for treatment of psoriasis: results of a multicenter study. Asawanonda P, Anderson RR, Chang Y, Taylor CR. Dong J, He Y, Zhang X, Wang Y, Tian Y, Wang J. Several features of It is often combined with topical therapies to enhance response, for instance, topical calcineurin inhibitors and topical steroids . 21 December 2012. 2011;13:47–49. A 308-nm excimer laser for the treatment of scalp psoriasis. 2012. 2015;41(11):1201–1211. The excimer laser was invented in 1970 by Nikolai Basov et al by using a xenon dimer (Xe2). Treatment of psoriasis and long-term maintenance using 308 nm excimer laser, clobetasol spray, and calcitriol ointment: a case series. J Lasers Med Sci. XTRAC is the only FDA-cleared, clinically proven excimer laser that gets skin clear of psoriasis—and it works fast, with many patients seeing significant improvement and long-lasting remissions. More specifically, inflammatory cells such as dendritic cells, macrophages, and CD3+ T cells and CD8+ T cells are detected in the dermis, whereas neutrophils and some CD3+ T cells and CD8+ T cells are detected in the epidermis.5 The aforementioned synopsis of the pathogenesis and pathophysiology of psoriasis will be crucial for the understanding of the mechanism of action of the excimer laser. It has a range of efficacies depending on the protocol used with several different treatment protocols, including the induration protocol, the minimal erythema dose protocol, and the newer minimal blistering dose protocol. Beggs S, Short J, Rengifo-Pardo M, Ehrlich A. The UVB emitted from the laser helps regulate the p53 tumor suppressor pathway inducing cell cycle arrest and deterring inflammatory processes.15 As a result, repigmentation of the treated areas is thought to occur due to elevated levels of peptide ET-1, as well as melanocyte re-migration and proliferation.1 With this knowledge, the utilization of the excimer laser has been expanded to include a host of various cutaneous diseases. They investigated the use of excimer laser for treatment of 10 patients with chronic plaque psoriasis and concluded that it was an effective treatment option.15 Since its initial introduction to dermatology, use of the excimer laser as a treatment option has expanded to applications in many dermatologic diseases. Epub 2020 Feb 14. 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. We also retain data in relation to our visitors and registered users for internal purposes and for sharing information with our business partners. 2007 Dec;23(6):238-41. doi: 10.1111/j.1600-0781.2007.00317.x. J Dermatolog Treat. 2014;5:8–12. With the recent development of highly effective biologic and systemic agents, it may be difficult to justify the monotherapy of excimer laser alone in patients with moderate to severe psoriasis, but with the demonstrated efficacy in combination with topicals and the ability to improve symptoms of refractory psoriasis, the excimer laser should continue to remain an excellent treatment option. Methods: A literature search on PubMed was used with combinations of the terms “excimer”, “excimer laser”, “308 nm”, “psoriasis”, “protocol”, “safety”, “efficacy”, acceptability”, “side effects”, and “dose”. Spencer JM, Hadi SM. Single blinded left-to-right comparison study of excimer laser versus pulsed dye laser for the treatment of nail psoriasis. It is a complex immune-mediated disease propagated by abnormal interactions between T lymphocytes, dendritic cells, keratinocytes, neutrophils, and proinflammatory cytokines. When treating patients with the excimer laser it is important to identify both the optimal patient candidate and the appropriate treatment protocol. COVID-19 is an emerging, rapidly evolving situation. IBM News Room. Resolution in these patients generally requires more treatments than non-intertriginous psoriatic lesions. There were a variety of treatment protocols that were identified for the treatment of psoriasis with the excimer laser. The patients were assessed with the Nail Psoriasis Severity Index (NAPSI). The laser is particularly useful if these individuals have a suboptimal response or contraindications to topical or intralesional treatments. Clinical efficacy of flumetasone/salicylic acid ointment combined with 308-nm excimer laser for treatment of psoriasis vulgaris. Unlike conventional light therapies, the XTRAC excimer laser delivers a highly targeted therapeutic beam of UVB light to areas of the skin affected by psoriasis without harming the surrounding skin so you can LIVE CLEAR. After 5 weeks of therapy (receiving a total of nine excimer laser treatments and clobetasol spray twice daily) the patients’ hairline psoriasis was completely cleared. In order to provide our website visitors and registered users with a service tailored to their individual preferences we use cookies to analyse visitor traffic and personalise content. 2015;41(11);1201–1211. Plaque-based sub-blistering dosimetry: reaching PASI-75 after two treatments with 308-nm excimer laser in a generalized psoriasis patient. However, it is important to consider patient goals in treatment when identifying the appropriate treatment protocol. 2007. The patient was then treated for 12 days following the initial treatment at a sub-blistering does of 800 mJ. The 308 nm can also be used in the treatment of mild to moderate plaque psoriasis in children. Photodermatol Photoimmunol Photomed. Nestle F, Kaplan D, Barker J. Psoriasis. Volume 2016:6 Pages 165—173, Editor who approved publication: J Drugs Dermatol. This work is published and licensed by Dove Medical Press Limited. 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. The United States Federal Drug Administration approved the XTRAC (Excimer) laser for psoriasis therapy in 2009. Furthermore, Kagen et al demonstrated that very high doses of excimer laser treatment in psoriatic lesions reduced the numbers of pathogenic memory/effector T cells infiltrating lesional epidermis and dermis.7, While the importance of the excimer laser in the treatment of psoriasis will be discussed, it is interesting to note the origins of the excimer laser. Abrouk M, Levin E, Brodsky M, Gandy JR, Nakamura M, Zhu TH, Farahnik B, Koo J, Bhutani T. Psoriasis (Auckl). Excimer can also be used for different types of … Different approaches regarding dose fluency, number of treatments, and maintenance have been utilized, and there is yet to be a consensus on standard protocol. It can treat any area on your body , including psoriasis on … Effectiveness Usually, two to three treatments with the excimer laser a week for about 10 to 15 weeks will achieve substantial improvement in a plaque of psoriasis. 2). Each of these protocols make use of different features of the patients’ psoriasis to help determine the optimal dosimetry when utilizing the excimer laser. After 5weeks, 1session per week, the condition significantly improved (Fig. You can learn about our use of cookies by reading our Privacy Policy. 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.  |  Clin Orthop Relat Res. Excimer laser treatment is highly effective in psoriasis, another T cell–mediated disorder that shares many immunologic features with AA. In addition to psoriasis, a vast number of other cutaneous diseases can also be treated with the excimer laser. This suggests that not only can the excimer laser be used in combination therapy, but it may even be more efficacious to utilize the laser in combination.43, Although the excimer laser is often not a first-line treatment for psoriasis patients, it can be useful in combination or in the treatment of patients who are refractory to other treatments (Figure 4). 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. •  Testimonials   For example, one study demonstrated improvement with 21 sessions.25,26, Adjunctive topical therapies can also be used to augment the laser’s results. 2012;28:133–136. We performed a PubMed search for studies describing excimer laser treatment protocol with particular attention to dosage determination, dose adjustment, dose fluency, number of treatments, and maintenance. 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