All patients improved, and 49% of the patients cleared completely. 2005;22:161–165. All studies determined the initial treatment dose using either the minimal erythema dose (MED) or induration. Objective: Loughran M. President Obama honors IBM scientists with National Medal Of Technology And Innovation for Breakthrough That Enabled LASIK Surgery. The excimer laser has been used successfully in patients with AA. Open access peer-reviewed scientific and medical journals. 2015;20:5–7. Background: Traditionally, treatment with the excimer laser requires determining the minimal erythema dose on healthy skin or using plaque-based induration; however, these protocols often lead to underdosing of psoriatic plaques and reduced treatment efficacy. Excimer laser therapy is an option for the treatment of localised vitiligo and moderately severe localised psoriasis and unresponsive to topical treatments. Morison WL, Atkinson D, Werthman L. Effective treatment of scalp psoriasis using the excimer (308 nm) laser. 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 little to no side effects. Physica-Verlag, Springer: Heidelberg. Applications of the excimer laser: a review. Lasers Surg Med. J Dermatolog Treat. 308-nm excimer laser for the treatment of psoriasis: induration-based dosimetry. 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. There were a variety of treatment protocols that were identified for the treatment of psoriasis with the excimer laser. Single blinded left-to-right comparison study of excimer laser versus pulsed dye laser for the treatment of nail psoriasis. Levin E, Debbaneh M, Malakouti M, et al. 2015;26:16–18. 308-nm excimer laser for the treatment of scalp psoriasis. Excimer lasers provide the benefits of NB-UVB but can be used on smaller treatment areas, such as the elbow or knee, for particularly stubborn plaques of psoriasis.  |  Dermatol Surg. •  software development by maffey.com The three main protocols that were identified were the MED protocol, the Induration protocol, and the MBD protocol. The Nobel Prize in Physics 1964. 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”. 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. Appropriate patient selection is important when considering excimer laser treatment for psoriasis. Excimer Laser. We offer real benefits to our authors, including fast-track processing of papers. •  Terms & Conditions   Even psoriasis that has been refractory to systemic treatments have been demonstrated to show improvement with the excimer laser. 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. The patient was subsequently treated with high-dose excimer laser therapy and demonstrated a rapid improvement in PASI scoring. Photodermatol, Photoimmunol, Photomed. 2020 Jul;20(1):52-55. doi: 10.3892/etm.2020.8529. Therapeutic modalities for localized psoriasis: 308-nm UVB excimer laser versus nontargeted phototherapy. J Drugs Dermatol. Mafong EA, Friedman PM, Kauvar AN, et al. Based on our reviewed studies, there is no consensus for a single excimer laser therapy protocol and as a result, patient preferences should continue to be an important consideration for phototherapy regimen planning. Key words: excimer laser, psoriasis, lymphocytic apoptosis, decreased ... minimal erythema dose protocol. Abrouk M, Levin E, Brodsky M, Gandy JR, Nakamura M, Zhu TH, Farahnik B, Koo J, Bhutani T. Psoriasis (Auckl). 1984;4:201–206. Having used traditional light boxes in my practice for many years, I was somewhat skeptical about using excimer laser therapy for psoriasis. Asawanonda P, Anderson RR, Chang Y, Taylor CR. •  Testimonials   Dove Medical Press is part of Taylor & Francis Group, the Academic Publishing Division of Informa PLC Lasers Surg Med. 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. Wong JW, Kamangar F, Nguyen TV, Koo JY. 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. It became clear in assessing these various protocols that the most efficacious protocol was the MBD protocol, in which patients were treated all the way up to a sub-blistering starting dose, and followed accordingly with dose modulation as needed. Half of the scalp received excimer laser treatment, whereas the other half of the scalp served as a control. The 308 nm can also be used in the treatment of mild to moderate plaque psoriasis in children. A maintenance protocol for psoriasis plaques cleared by the 308 nm excimer laser. 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. (Although less commonly used, the proper term for such is an exciplex laser.). Effective treatment of etanercept and phototherapy-resistant psoriasis using the excimer laser. Many patients who achieve clearance with the excimer laser treatment remain relapse free for several months or more before requiring re-treatment with the laser. 2003;361:1197–1204. Of the 21 patients who completed the protocol, 76% achieved at least PASI-75 by week 12. Objective: To prospectively evaluate the effect of the excimer laser on plaque psoriasis using an optimal therapeutic dose (OTD) protocol. UK VAT Group: GB 365 4626 36. 2000;136:619–624. 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. Efficacy of the 308-nm excimer laser for treatment of psoriasis: results of a multicenter study. Excimer can also be used for different types of … The excimer laser has been demonstrated to be an effective treatment option for psoriasis variants and locations that may be more difficult to treat with topical modalities.32, The scalp is involved in up to 80% of patients with psoriasis, and the excimer laser can be useful in the treatment of scalp psoriasis. 2014;5:8–12. This scalp psoriasis was refractory to topical corticosteroids and acitretin. In a comparison study the excimer laser versus the pulsed dye laser (PDL) was evaluated for the treatment of nail psoriasis in 42 patients. eCollection 2016. Javascript is currently disabled in your browser. J Am Acad Dermatol. 2). There have been five prospective studies investigating the use of excimer laser in the treatment of palmoplantar pustular psoriasis. The mechanism of action of the excimer laser, similar to the action of UVB light, induces apoptosis in keratinocytes and T lymphocytes. 2015;26:45–48. Keywords: excimer, laser, 308 nm, psoriasis, safety, efficacy. Am J Ophthalmol. Applications of the excimer laser: a review. 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 … This is often useful for patients with limited scalp involvement.35, Treatment of scalp psoriasis has been reported, but this modality presents challenges due to the difficulty of penetrating the laser through the hair. 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. This site needs JavaScript to work properly. 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. Frentzen M, Koort HJ, Thiensiri I. Excimer lasers in dentistry: future possibilities with advanced technology. The above percentage of manuscripts have been rejected in the last 12 months. When compared to the narrow band UVB laser, the 308 nm laser has an increased induction rate of T-cell apoptosis.1 Compared with traditional narrow band UV therapy, the excimer laser requires on average less number of treatment sessions and thus a smaller amount of cumulative UVB exposure. It means that the treatment will not work well for psoriasis cases that affect large parts of the body. A review of targeted ultraviolet B phototherapy for psoriasis. Different approaches regarding dose fluency, number of treatments, and maintenance have been utilized, and there is yet to be a consensus on standard protocol. Available from https://www-03.ibm.com/press/us/en/pressrelease/39829.wss. Quintessence Int. This is a discussion that should be had with patients and clinicians before treatment. Malakouti M, Brown GE, Sorenson E, Leon A, Koo J, Levin EC. Pahlajani N, Katz BJ, Lozano AM, Murphy F, Gottlieb A. Excimer lasers aim a high intensity ultraviolet B (UVB) light dose of a very specific wavelength -- 308 nanometers -- directly at the psoriasis plaques. The laser is particularly useful if these individuals have a suboptimal response or contraindications to topical or intralesional treatments. 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. 2001;137:95–96. J Drugs Dermatol. Figure 4 Psoriasis therapeutic armamentarium. THE XTRAC ® ADVANTAGE. 2011;13:47–49. One study by Asawanonda et al extrapolates dosing in millijoules from a mean MED of 203.3 mJ to correlate with ~3.248 mJ.21,22, The induration-based protocol is another method for determining treatment dosing. Guidelines of care for the management of psoriasis and psoriatic arthritis. Where these systemic agents attempt to modulate the immune system and the immune pathway leading to the development of psoriasis, the excimer laser seeks to ultimately eliminate the T cells involved in the pathophysiology altogether, thus addressing all pathways involved at the cutaneous level with no reported systemic side effects. If someone has only a few isolated patches of psoriasis, excimer laser therapy can target their UVB treatment. Number 3099067. 2012;11:994–996. Photodermatol Photoimmunol Photomed. 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. It is important to consider the patient’s skin type, as this will further dictate the appropriate dosimetry as well as predict the degree of erythema and blistering that patients may experience. Because XTRAC delivers a highly targeted, therapeutic beam of UVB light only to areas of the skin affected by psoriasis, healthy skin surrounding the lesions stays that way. This protocol identifies the minimum dose at which the patient will blister, and then subsequent treatments are administered at doses less than the MBD. This demonstrated that the combination of excimer laser with alternating clobetasol spray and calcitriol ointment is a promising option and can easily be implemented in any treatment involving the excimer laser.30, In another 12-week study Levin et al treated moderate to severe psoriasis patients with twice weekly excimer treatments combined with twice daily clobetasol propionate followed by calcitriol ointment twice daily. Plaque-based sub-blistering dosimetry: reaching PASI-75 after two treatments with 308-nm excimer laser in a generalized psoriasis patient. 2007. J Eur Acad Dermatol. This FDA-approved method uses a … National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. The excimer laser can be used to treat palmoplantar pustular psoriasis, as well as scalp and nail psoriasis, which are historically hard to treat subtypes. In 1997, Bonis et al 7 also reported that the 308-nm XeCl excimer laser was useful in the treatment of psoriasis. The Lancet. Several different treatment protocols have been developed and optimized to more effectively treat psoriatic lesions and to achieve greater improvements in the PASI score with fewer treatments. In theory, this achieves the maximum possible dose that a plaque can sustain without blistering the skin. The excimer laser is superior in inducing T cell apoptosis in vitro compared with narrowband UVB, with paralleled improved clinical efficacy. •  Privacy Policy   The excimer laser has also been demonstrated to be an excellent treatment option for difficult to treat psoriasis subtypes. It must be noted however that the forehead, hairline, and retroauricular areas are not entirely covered by hair, and often treatment with the excimer laser is a viable option.36 Wong et al present a case of a 68-year-old female patient with generalized plaque psoriasis, also involving the hairline of the scalp. It has been demonstrated that the excimer laser can be an effective treatment option even for psoriasis that has failed treatment with biologic agents. excimer laser. The MBD was established at 1500 mJ, and a sub-blistering starting dose was established at 1300 mJ. ability to treat mi ld, moderate and eve n severe but localised. Treatment of inverse psoriasis with the 308 nm excimer laser. On average, 12.5 (SD 2.64) treatments were needed for resolution in children, while 9.7 (SD 2.53) sessions were needed for adults. You can learn about our use of cookies by reading our Privacy Policy. The excimer laser was invented in 1970 by Nikolai Basov et al by using a xenon dimer (Xe2). A tapering of laser treatments may be beneficial in maintaining the level of plaque clearance obtained from biweekly laser treatments. Resolution in these patients generally requires more treatments than non-intertriginous psoriatic lesions. 2012;28:184–190. It is often combined with topical therapies to enhance response, for instance, topical calcineurin inhibitors and topical steroids . Mudigonda T, Dabade T, Feldman S. A review of targeted ultraviolet B phototherapy for psoriasis. Mehraban S, Feily A. 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. 2009;361:496–509. 8 They demonstrated that the cumulative dose for complete clearance was 6.47 times less with the excimer laser than with traditional NB-UVB and that the number of treatments … The 308 nm excimer laser was initially studied for the treatment of moderate plaque psoriasis by Bonis et al in 1997. When treating patients with the excimer laser it is important to identify both the optimal patient candidate and the appropriate treatment protocol. 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