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This intra-patient randomized comparative study aimed to distinguish between the safety and efficacy of combination therapy of 10,600 nm fractional carbon dioxide laser (Fr. CO2) + Methotrexate gel and Methotrexate 1% gel alone for treating psoriatic nails.
While intralesional Methotrexate injections are effective for psoriatic nails, the combination of fractional CO2 laser and Methotrexate 1% gel provides improved efficacy and patient satisfaction with less pain and time commitment.
This intra-patient randomized comparative study aimed to distinguish between the safety and efficacy of combination therapy of 10,600 nm fractional carbon dioxide laser (Fr. CO2) + Methotrexate gel and Methotrexate 1% gel alone for treating psoriatic nails.
A total of 36 patients with fingernail psoriasis were treated. In the Fr. CO2 group, one hand was randomly assigned to receive monthly sessions of 10,600 nm Fr. CO2 + Methotrexate 1% gel daily for 4 months. While in the non-laser group, only Methotrexate gel was used daily for the same period.
Evaluations were performed at the end of the 4-month treatment period and 3 months afterwards, both clinically and dermoscopically, with histopathological analysis implemented 3 months following the treatment.
The total Nail Psoriasis Severity Index (NAPSI) remarkably improved in both groups (P=0.001 for each hand), with no significant difference between the two by the end of the treatment.
The Fr. CO2 group exhibited a significantly greater reduction in NAPSI scores than the non-laser group (p = 0.001) 3 months post-treatment. As per the microscopic skin assessments, notable improvements in both hands at the end of the treatment and after 3 months were observed.
Microscopic examination of psoriatic nails indicated a substantial decrease in the nail plate and subungual thickness in both groups after 3 months, with the Fr. CO2 group displaying significantly greater improvements (p = 0.011, 0.000). Additionally, improvements in fluid accumulation in the nail plate and beneath the nail, hyperkeratosis, and Munro's microabscess were observed 3 months after treatment, with no substantial dissimilarities between these study groups.
Although 20% of patients in the Fr. CO2 group had minimal pain during the session and 37.1% had skin redness that lasted less than 24 hours, patient satisfaction was reported to be considerably higher with the use of this combination therapy (p = 0.02).
Topical application of Methotrexate 1% gel was effective for improving psoriatic nails. Nevertheless, the combination of Fr. CO2 laser with Methotrexate 1% gel was more effective than the application of Methotrexate 1% gel alone.
Achieves of Dermatological Research
Combined fractional CO2 laser 10,600 nm with methotrexate 1% gel versus methotrexate 1% gel alone in the treatment of nail psoriasis: a randomized comparative study
Nayera Hassan Moftah et al.
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