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Wong JW, Nguyen TV, Bhutani T, Koo JY. Overall, the 308 nm excimer laser is a very well tolerated treatment option for patients with psoriasis. Psoriasis vulgaris compromises more than 80% of cases, usually present with raised, well-demarcated, erythematous oval plaques with adherent silvery scale. 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. The Lancet. 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. 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). Pilot evaluation of supra-erythemogenic phototherapy with excimer laser in the treatment of patients with moderate to severe plaque psoriasis. These studies also confirm that an average of 10 treatments should clear the plaques.18–22, In addition to plaque psoriasis, the 308 nm laser is useful in the treatment of intertriginous psoriasis as demonstrated by a few case reports.23,24 Recently, split scalp studies have shown beneficial results of the laser in treating scalp psoriasis. 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. Number 3099067. Additionally, pretreatment and post-treatment biopsies were performed, and it was demonstrated that after treatment with high-dose excimer laser there was a 3-fold reduction in the number of live T cells found in the post-treatment biopsy. 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. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Excimer laser treatment is highly effective in psoriasis, another T cell–mediated disorder that shares many immunologic features with AA. 2006;22:181–183. Registered in England and Wales. Spencer JM, Hadi SM. We offer real benefits to our authors, including fast-track processing of papers. psoriasis plaques and plays an important role in … Fluency ranged from 0.5 MED (low) to 16 MED (high); one study demonstrated that medium to high fluencies yielded better improvement in fewer number of treatments. Taneja and colleagues innovated this method whereby an initial dose is based on the induration component of the modified PASI and subsequent doses are based on the change in induration. 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. Treatment of plaque-type psoriasis with the 308 nm excimer laser in combination with dithranol or calcipotriol. Different approaches regarding dose fluency, number of treatments, and maintenance have been utilized, and there is yet to be a consensus on standard protocol. High-dose 308-nm excimer laser for the treatment of psoriasis. Excimer lasers are used to treat mild-to-moderate psoriasis. 2003;361:1197–1204. 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. Successful use of the excimer laser for generalized psoriasis in an ustekinumab non-responder. The MBD was established at 1500 mJ, and a sub-blistering starting dose was established at 1300 mJ. 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. With a past history of cancer, the patient opted for excimer laser treatment in conjunction with clobetasol prionate (0.05%) spray twice daily. 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. Fluency adjustments during the course of treatment were important to minimize phototherapy-associated side effects. •  software development by maffey.com Excimer laser therapy is an option for the treatment of localised vitiligo and moderately severe localised psoriasis and unresponsive to topical treatments. Glossop ND, Jackson RW, Koort HJ, Reed SC, Randle JA. 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. IBM News Room. •  Recommend this site Morison WL, Atkinson DF, Werthman L. Effective treatment of scalp psoriasis using the excimer (308 nm) laser. 2009;361:496–509. This work is published and licensed by Dove Medical Press Limited. In theory, this achieves the maximum possible dose that a plaque can sustain without blistering the skin. In a comparison study the excimer laser versus the pulsed dye laser (PDL) was evaluated for the treatment of nail psoriasis in 42 patients. The PHAROS excimer laser is different from cosmetic lasers that are usually associated with pain during treatment and post-treatment downtime for the patient. Photodermatol Photoimmunol Photomed. These side effects are dependent on the treatment protocol utilized, as certain protocols like the MBD protocol require a more aggressive dosimetry, which may induce further side effects. Results: Although the laser has demonstrated clinical efficacy, there is a lack of literature outlining the safety, efficacy, and patient acceptability of the excimer laser. When using the excimer laser to treat psoriasis, you need to keep in mind that the light involved is concentrated. open access to scientific and medical research. All studies determined the initial treatment dose using either the minimal erythema dose (MED) or induration. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms. 1997;350:1522. The 308 nm can also be used in the treatment of mild to moderate plaque psoriasis in children. Although the excimer laser has been demonstrated to be a very effective treatment, further studies are required to identify its role in the modern dermatology armamentarium. Excimer laser therapy for hairline psoriasis: a useful addition to the scalp psoriasis treatment algorithm. •  Associations & Partners   Treatment for palmoplantar pustular psoriasis: systematic literature review, evidence-based recommendations and expert opinion. 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. 2001;137:95–96. From submission to first editorial decision. Excimer laser for psoriasis treatment: A case report and short review. 2015;41(11);1201–1211. XTRAC is also endorsed by the National Psoriasis Foundation and the technology is part of the approved clinical protocols recommended by the American Academy of Dermatology. Compared to the MED protocol, the induration method allows for clinicians to modify the dose as plaques begin to change in response to treatment. 2007 Dec;23(6):238-41. doi: 10.1111/j.1600-0781.2007.00317.x. To characterize treatment parameters for 308 nm excimer laser phototherapy. After 4 weeks of treatment with the excimer laser, the patient demonstrated a PASI-75 response, and after 7 weeks of treatment the patient achieved a PASI-95 response.45. The conclusion was that psoriasis required 7 to 11 treatment sessions to clear. (Although less commonly used, the proper term for such is an exciplex laser.). J Am Acad Dermatol. J Drugs Dermatol. J Am Acad Dermatol. It is possible that this is all related to the different mechanisms of action for the excimer laser compared to more systemic or biologic agents. 2014;28:13–16. 2003;139:759–764. Am J Ophthalmol. Please enable it to take advantage of the complete set of features! 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. Lasers Surg Med. Clinical efficacy of a 308 nm excimer laser for treatment of psoriasis vulgaris. Would you like email updates of new search results? This FDA-approved method uses a … Although treatment with biologic agents can decrease the levels of inflammatory cytokines, the excimer laser has the ability to directly cause apoptosis of T cells and induce DNA damage in the antigen-presenting cells, which the authors attribute to the superior response observed from the excimer laser compared to ustekinumab.44. Kemeny L, Bonis B, Dobozy A, Bor Z, Szabó G, Ignácz F. 308-nm excimer laser therapy for psoriasis. •  Terms & Conditions   Resolution in these patients generally requires more treatments than non-intertriginous psoriatic lesions. Epub 2011 Oct 14. 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. Key words: excimer laser, psoriasis, lymphocytic apoptosis, decreased ... minimal erythema dose protocol. Ardeleanu V, Sabina Radaschin D, Tatu AL. Additionally, there is currently no long-term safety data on the effects of the more aggressive MBD treatment with regard to side effects and risk for long-term skin damage with high-dose treatments. The major side effects identified were erythema, tenderness, and blistering at the sites of treatment. Volume 2016:6 Pages 165—173, Editor who approved publication: Open access peer-reviewed scientific and medical journals. Malakouti et al demonstrated the efficacy of the excimer laser in treating a 63-year-old Asian male with moderate to severe plaque psoriasis that had previously failed treatment with 28 weeks of ustekinumab therapy.  |  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. Conclusion: The 308 nm excimer laser is an effective therapy for psoriasis regardless of the method used to determine initial dosage, dose fluency, or number of treatments. Carrascosa JM, Soria X, Domingo H, Ferrandiz C. Treatment of inverse psoriasis with excimer therapy and tacrolimus ointment. 2004;34:136–140. 1995;72–81. Photodermatol Photoimmunol Photomed. 2012;28:293–298. Plaque-based sub-blistering dosimetry: reaching PASI-75 after two treatments with 308-nm excimer laser in a generalized psoriasis patient. Because the laser light never touches the surrounding skin, it reduces the risk of UV radiation exposure. Although the PDL laser performed better than the excimer laser for the treatment of nail psoriasis, 38% of hands treated with the excimer laser achieved NAPSI-50, an improvement of at least 50% in nail psoriasis.39, Palmoplantar pustular psoriasis is another subtype of psoriasis that can often be difficult to treat. eCollection 2016. J Dermatolog Treat. Results: The 308 nm excimer laser is generally safe and well tolerated with minimal side effects including erythema, blistering, and pigmentary changes. Figure 4 Psoriasis therapeutic armamentarium. Pediatr Dermatol. The absorption of 308 nm wavelength induces DNA breakage, upregulation of the tumor suppressor gene p53, and subsequent reduction of proto-oncogene Bcl-2, leading to cell cycle arrest in keratinocytes and T lymphocytes.1 This breaks the positive feedback loop and halts the psoriatic disease cycle created by the activated T lymphocytes. All rights reserved. Photodermatol Photoimmunol Photomed. Physica-Verlag, Springer: Heidelberg. 308 nm excimer laser phototherapy is efficacious in the treatment of localized psoriasis. In addition to psoriasis, a vast number of other cutaneous diseases can also be treated with the excimer laser. Beggs S, Short J, Rengifo-Pardo M, Ehrlich A. 2015;21. Epub 2019 Jul 6. 308 nm UVB excimer laser for psoriasis. UK VAT Group: GB 365 4626 36. We also retain data in relation to our visitors and registered users for internal purposes and for sharing information with our business partners. 2006;22:181–183. If clearance in the fastest possible time is the goal, the MBD protocol would be the best option. J Drugs Dermatol. For example, in the case aforementioned, the patient was tested with doses ranging from 300 to 1700 mJ. Abbreviation: MED, minimal erythema dose. J Lasers Med Sci. The Lancet. 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 … 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. Mudigonda T, Dabade T, Feldman S. A review of targeted ultraviolet B phototherapy for psoriasis. 2014 Sep 15;7(9):2844-50. eCollection 2014. 21 December 2012. Clin Orthop Relat Res. 2007. It has been shown to be an effective treatment option in combination therapy with topicals as well as a treatment option for psoriasis refractory to systemic treatment. The opinions expressed in all articles published here are those of the specific author(s), and do not necessarily reflect the views of Dove Medical Press Ltd or any of its employees. 2014;4:197–205. 2012;28:133–136. The excimer laser has been adopted by other medical disciplines such as cardiology, dentistry, and orthopedics.12–14. NIH 308-nm excimer laser for the treatment of scalp psoriasis. Figure 3 Common side effects of the 308 nm excimer laser in the treatment of psoriasis. There were a variety of treatment protocols that were identified for the treatment of psoriasis with the excimer laser. It can treat any area on your body , including psoriasis on … 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.  |  Mafong EA, Friedman PM, Kauvar AN, et al. Exp Ther Med. The excimer laser has been used successfully in patients with AA. The initiation of psoriasis begins with an amalgamation between environment and genetic factors. The patient was then treated for 12 days following the initial treatment at a sub-blistering does of 800 mJ. 2020 Jul;20(1):52-55. doi: 10.3892/etm.2020.8529. Even psoriasis that has been refractory to systemic treatments have been demonstrated to show improvement with the excimer laser. 2000;136:619–624. USA.gov. Photodermatol, Photoimmunol, Photomed. 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. Treatment of psoriasis and long-term maintenance using 308 nm excimer laser, clobetasol spray, and calcitriol ointment: a case series. Terminology and history. 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. The excimer lasers. The patient was subsequently treated with high-dose excimer laser therapy and demonstrated a rapid improvement in PASI scoring. Dove Medical Press is a member of the OAI. 2015;41(11):1201–1211. 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. Javascript is currently disabled in your browser. Arch Dermatol. Figure 2 Plaque type psoriasis on lower extremity after eight treatments with excimer laser according to MED protocol. The patient was subsequently discontinued from all prior treatments and started on excimer laser treatments twice weekly. Lasers Surg Med. 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. It has been demonstrated that the excimer laser can be an effective treatment option even for psoriasis that has failed treatment with biologic agents. Each of these protocols make use of different features of the patients’ psoriasis to help determine the optimal dosimetry when utilizing the excimer laser. 2004;140:518–520. Objective: To characterize treatment parameters for 308 nm excimer laser phototherapy. In this report, we present the case of a patient diagnosed with plaque psoriasis, resistant to topical ointments, successfully treated with the 308 nm excimer laser. You can learn about what data of yours we retain, how it is processed, who it is shared with and your right to have your data deleted by reading our Privacy Policy. If you agree to our use of cookies and the contents of our Privacy Policy please click 'accept'. 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. Linsker R, Srinivasan R, Wynne JJ, Alonso DR. Far-ultraviolet laser ablation of atherosclerotic lesions. Levin E, Debbaneh M, Malakouti M, et al. The excimer laser is superior in inducing T cell apoptosis in vitro compared with narrowband UVB, with paralleled improved clinical efficacy. Background: J Am Acad Dermatol. Sevrain M, Richard MA, Barnetche T, et al. The treatment protocol used in that study involved stepwise dose increments similar to conventional phototherapy. 2012;11:92–97. Patients who were assessed in the aforementioned studies were often patients with mild to moderate psoriasis. 2). Manual separation of the hair was used to provide access, and starting doses ranged from 300 to 1000 mJ depending on Fitzpatrick skin type. The above percentage of manuscripts have been rejected in the last 12 months. The use of higher fluencies was reported to result in higher occurrences of blistering. 2011;13:47–49. The XTRAC excimer laser is safe and effective, dermatologist recommended and covered by all major insurances. 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. The excimer laser has also been demonstrated to be an excellent treatment option for difficult to treat psoriasis subtypes. 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. Frentzen M, Koort HJ, Thiensiri I. Excimer lasers in dentistry: future possibilities with advanced technology. 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. 1983;96(8):710–715. 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. Having used traditional light boxes in my practice for many years, I was somewhat skeptical about using excimer laser therapy for psoriasis. The 308 nm excimer laser was initially studied for the treatment of moderate plaque psoriasis by Bonis et al in 1997. 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. This laser focuses a single band of ultraviolet B (UVB) light on psoriasis sores. A maintenance protocol for psoriasis plaques cleared by the 308 nm excimer laser. Self-control study of combination treatment of 308 nm excimer laser and calcipotriene ointment on stable psoriasis vulgaris. 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. Prof. Dr. Uwe Wollina, Michael Abrouk,1 Ethan Levin,2 Merrick Brodsky,1 Jessica R Gandy,1 Mio Nakamura,2 Tian Hao Zhu,3 Benjamin Farahnik,4 John Koo,2 Tina Bhutani2 1Irvine School of Medicine, Irvine, 2Department of Dermatology, Psoriasis and Skin Treatment Center, University of California, San Francisco, 3Department of Dermatology, University of Southern California Keck School of Medicine, Los Angeles, CA, 4Department of Dermatology, University of Vermont College of Medicine, Burlington, VT, USA Introduction: The 308 nm excimer laser is a widely used device throughout the field of dermatology for many diseases including psoriasis. Laser therapy is an option for patients with AA Federal Drug Administration approved the XTRAC excimer according! And expert opinion can target their UVB treatment caused excessive skin growth radiation exposure by using xenon. Please enable it to take advantage of the 308-nm excimer laser for psoriasis please see paragraphs and. 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