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Lasers for Psoriasis and Hypopigmentation

  • Laura Jordan
  • Summer Moon
  • James M. Spencer
Chapter

Abstract

Psoriasis and pigmentary disorders have a profound impact on the quality of life of affected patients. Despite multiple medical therapies for psoriasis, certain clinical scenarios present therapeutic dilemmas. The excimer laser has been found to be efficacious not only for patients suffering from psoriasis but also for several disorders of hypopigmentation including vitiligo, linear scleroderma, pityriasis alba, and chemical, punctate, and post-resurfacing leucoderma. Additionally, due to the excimer laser’s reduced cumulative dose and number of treatment sessions, it offers several potential advantages over whole-body phototherapy, including lowered carcinogenicity, phototoxicity, and cost of treatment. This paper considers the variety of applications for the excimer laser on psoriasis and hypopigmentation and reviews its associated indications, contraindications, techniques, adverse events, and future directions.

Keywords

Excimer laser Psoriasis Vitiligo Pigmentary disorders Hypopigmentation Leucoderma Scleroderma Pityriasis alba Psoralen and ultraviolet A (PUVA) Minimal erythema dose (MED) Light therapy Tacrolimus 

References

  1. 1.
    Bónis B, Kemény L, Dobozy A, Bor Z, Szabó G, Ignácz F. 308 nm UVB excimer laser for psoriasis. Lancet. 1997;350:1522.CrossRefGoogle Scholar
  2. 2.
    Parrish JA, Jaenicke KF. Action spectrum for phototherapy of psoriasis. J Invest Dermatol. 1981;76:359–62.CrossRefGoogle Scholar
  3. 3.
    Specchio F, Carboni I, Cannarozzo G, Tamburi F, Dattola E, Nisticò S. Excimer UV radiation in dermatology. Int J Immunopathol Pharmacol. 2014;27(2):287–9.CrossRefGoogle Scholar
  4. 4.
    Mudigonda T, Dabade TS, Feldman SR. A review of targeted ultraviolet B phototherapy for psoriasis. J Am Acad Dermatol. 2012;66(4):664–72.CrossRefGoogle Scholar
  5. 5.
    Spencer JM, Hadi SM. The excimer lasers. J Drugs Dermatol. 2004;3:522–5.PubMedGoogle Scholar
  6. 6.
    Kemény L, Bónis B, Dobozy A, Bor Z, Szabó G, Ignácz F. 308-nm excimer laser therapy for psoriasis. Arch Dermatol. 2001;137:95–6.PubMedGoogle Scholar
  7. 7.
    Feldman SR, Mellen BG, Housman TS, Fitzpatrick RE, Geronemus RG, Friedman PM, et al. Efficacy of the 308 nm excimer laser for treatment of psoriasis: results of a multicenter study. J Am Acad Dermatol. 2002;46:900–6.CrossRefGoogle Scholar
  8. 8.
    Erceg A, Bovenschen HJ, van de Kerkhof PC, Seyger MM. Efficacy of the pulsed dye laser in the treatment of localized recalcitrant plaque psoriasis: a comparative study. Br J Dermatol. 2006;155:110–4.CrossRefGoogle Scholar
  9. 9.
    Ilknur T, Akarsu S, Aktan S, Ozkan S. Comparison of the effects of pulsed dye laser, pulsed dye laser + salicylic acid, and clobetasole propionate + salicylic acid on psoriatic plaques. Dermatol Surg. 2006;32:49–55.CrossRefGoogle Scholar
  10. 10.
    Bovenschen HJ, Erceg A, Van Vlijmen-Willems I, Van De Kerkhof PC, Seyger MM. Pulsed dye laser versus treatment with calcipotriol/betamethasone dipropionate for localized refractory plaque psoriasis: effects on T-cell infiltration, epidermal proliferation and keratinization. J Dermatol Treat. 2007;18:32–9.CrossRefGoogle Scholar
  11. 11.
    Al-Mutairi N, Noor T, Al-Haddad A. Single blinded left-to-right comparison study of excimer laser versus pulsed dye laser for the treatment of nail psoriasis. Dermatol Ther (Heidelb). 2014;4(2):197–205. Epub 2014 Jul 3.CrossRefGoogle Scholar
  12. 12.
    Kagen M, Cao LY, Oyetakin-White P, Tacastacas JD, Yan C, McCormick TS, et al. Single administration of lesion-limited high-dose (TURBO) ultraviolet B using the excimer laser: clinical clearing in association with apoptosis of epidermal and dermal T cell subsets in psoriasis. Photodermatol Photoimmunol Photomed. 2012;28(6):293–8.CrossRefGoogle Scholar
  13. 13.
    Tang YJ, Xu WW, Liu XM, Zhang RZ, Xu CX, Xu B, et al. Self-control study of combination treatment of 308 nm excimer laser and calcipotriene ointment on stable psoriasis vulgaris. Int J Clin Exp Med. 2014;7(9):2844–50. eCollection 2014.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Dong J, He Y, Zhang X, Wang Y, Tian Y, Wang J. Clinical efficacy of flumetasone/salicylic acid ointment combined with 308-nm excimer laser for treatment of psoriasis vulgaris. Photodermatol Photoimmunol Photomed. 2012;28(3):133–6.CrossRefGoogle Scholar
  15. 15.
    Rogalski C, Grunewald S, Schetschorke M, Bodendorf MO, Kauer F, Simon JC, et al. Treatment of plaque-type psoriasis with the 308 nm excimer laser in combination with dithranol or calcipotriol. Int J Hyperth. 2012;28(2):184–90.CrossRefGoogle Scholar
  16. 16.
    Hadi S, Tinio P, Al-Ghaithi K, Al-Qari H, Al-Helalat M, Lebwohl M, et al. Treatment of vitiligo using the 308-nm excimer laser. Photomed Laser Surg. 2006;24:354–7.CrossRefGoogle Scholar
  17. 17.
    Cheng YP, Chiu HY, Jee SH, Tsai TF. Excimer light photototherapy of segmental and non-segmental vitiligo: experience in Taiwan. Photodermatol Photoimmunol Photomed. 2012;28(1):6–11.CrossRefGoogle Scholar
  18. 18.
    Kawalek AZ, Spencer JM, Phelps RG. Combined excimer laser and topical tacrolimus for the treatment of vitiligo: a pilot study. Dermatol Surg. 2004;30:130–5.PubMedGoogle Scholar
  19. 19.
    Nisticò S, Chiricozzi A, Saraceno R, Schipani C, Chimenti S. Vitiligo treatment with monochromatic excimer light and tacrolimus: results of an open randomized controlled study. Photomed Laser Surg. 2012;30(1):26–30.  https://doi.org/10.1089/pho.2011.3029. Epub 2011 Nov 4.CrossRefPubMedGoogle Scholar
  20. 20.
    Hui-Lan Y, Xiaio-Yan H, Jian-Yong F, Zong-Rong L. Combination of the 308-nm excimer laser with topical picrolimus for the treatment of childhood vitiligo. Pediatr Dermatol. 2009;26:354–6.CrossRefGoogle Scholar
  21. 21.
    Ebadi A, Rad MM, Nazari S, Fesharaki RJ, Ghalamkarpour F, Younespour S. The additive effect of excimer laser on non-cultured melanocyte-keratinocyte transplantation for the treatment of vitiligo: a clinical trial in an Iranian population. J Eur Acad Dermatol Venereol. 2014.  https://doi.org/10.1111/jdv.12674. [Epub ahead of print].CrossRefGoogle Scholar
  22. 22.
    Al-Shobaili HA. Treatment of vitiligo patients by excimer laser improves patients’ quality of life. J Cutan Med Surg. 2014;18(5):1–7.PubMedGoogle Scholar
  23. 23.
    Thomas C. Taber’s cyclopedic medical dictionary. 17th ed. Philadelphia: F.A. Davis Co; 1993. p. 1102.Google Scholar
  24. 24.
    Friedman PM, Geronemus RG. Use of the 308-nm excimer laser for post resurfacing leukoderma. Arch Dermatol. 2001;137:824–5.PubMedGoogle Scholar
  25. 25.
    Alexiades-Armenakas MR, Bernstein LJ, Friedman PM, Geronemus RG. The safety and efficacy of the 308-nm excimer laser for pigment correction of hypopigmented scars and striae alba. Arch Dermatol. 2004;140:955–60.CrossRefGoogle Scholar
  26. 26.
    Goldberg DJ, Sarradet D, Hussain M. 308-nm excimer laser treatment of mature hypopigmented striae. Dermatol Surg. 2003;29:596–9.PubMedGoogle Scholar
  27. 27.
    Ostovari N, Saadat N, Nasiri S, Moravvej H, Toossi P. The 308-nm excimer laser in the darkening of the white lines of striae alba. J Dermatolog Treat. 2010;21(4):229–31.  https://doi.org/10.3109/09546631003592044.CrossRefPubMedGoogle Scholar
  28. 28.
    Ghazi E, Ragi J, Milgraum S. Treatment of chemical leukoderma using a 308-nm excimer laser. Dermatol Surg. 2012;38(8):1407–9.  https://doi.org/10.1111/j.1524-4725.2012.02443.x. Epub 2012 Jun 8.CrossRefPubMedGoogle Scholar
  29. 29.
    Vine K, Meulener M, Shieh S, Silverberg NB. Vitiliginous lesions induced by amyl nitrite exposure. Cutis. 2013;91(3):129–36.PubMedGoogle Scholar
  30. 30.
    Kim HS, Jung HD, Kim HO, Lee JY, Park YM. Punctate leucoderma after low-fluence 1,064-nm quality-switched neodymium-doped yttrium aluminum garnet laser therapy successfully managed using a 308-nm excimer laser. Dermatol Surg. 2012;38(5):821–3.  https://doi.org/10.1111/j.1524-4725.2012.02397.x. Epub 2012 Apr 27.CrossRefPubMedGoogle Scholar
  31. 31.
    Hanson AH, Fivenson DP, Schapiro B. Linear scleroderma in an adolescent woman treated with methotrexate and excimer laser. Dermatol Ther. 2014;27(4):203–5.  https://doi.org/10.1111/dth.12117. Epub 2014 Feb 18.CrossRefPubMedGoogle Scholar
  32. 32.
    Al-Mutairi N, Hadad AA. Efficacy of 308-nm xenon chloride excimer laser in pityriasis alba. Dermatol Surg. 2012;38(4):604–9.  https://doi.org/10.1111/j.1524-4725.2011.02223.x. Epub 2011 Nov 28.CrossRefPubMedGoogle Scholar
  33. 33.
    Lapolla W, Yentzer BA, Bagel J, Halvorson CR, Feldman SR. A review of phototherapy protocols for psoriasis treatment. J Am Acad Dermatol. 2011;64(5):936–49.CrossRefGoogle Scholar
  34. 34.
    Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy. J Am Acad Dermatol. 2010;62(1):114–35.CrossRefGoogle Scholar
  35. 35.
    Wong JW, Kamangar F, Nguyen TV, Koo JY. Excimer laser therapy for hairline psoriasis: a useful addition to the scalp psoriasis treatment algorithm. Skin Therapy Lett. 2012;17(5):6–9.PubMedGoogle Scholar
  36. 36.
    Sevrain M, Richard MA, Barnetche T, Rouzaud M, Villani AP, Paul C, et al. Treatment for palmoplantar pustular psoriasis: systematic literature review, evidence-based recommendations and expert opinion. J Eur Acad Dermatol Venereol. 2014; 28 Suppl 5:13–16.CrossRefGoogle Scholar
  37. 37.
    Totonchy MB, Chiu MW. UV-based therapy. Dermatol Clin. 2014;32(3):399–413.CrossRefGoogle Scholar
  38. 38.
    Schaarschmidt ML, Kromer C, Herr R, Schmieder A, Goerdt S, Peitsch WK. Treatment satisfaction of patients with psoriasis. Acta Derm Venerol. 2014.  https://doi.org/10.2340/00015555-2011. [Epub ahead of print].CrossRefGoogle Scholar
  39. 39.
    Park KK, Liao W, Murase JE. A review of monochromatic excimer light in vitiligo. Br J Dermatol. 2012;167(3):468–78.CrossRefGoogle Scholar
  40. 40.
    Ortonne JP, Passeron T. Melanin pigmentary disorders: treatment update. Dermatol Clin. 2005;23:209–26.CrossRefGoogle Scholar
  41. 41.
    Shin JW, Yoon SW, Jeong JB, Park KC. Different responses of the melanin index to ultraviolet irradiation in relation to skin color and body site. Photodermatol Photoimmunol Photomed. 2014;30(6):308–15.CrossRefGoogle Scholar
  42. 42.
    Asawanonda P, Anderson RR, Chang Y, Taylor CR. 308 nm excimer laser for the treatment of psoriasis: a dose-response study. Arch Dermatol. 2000;136:619–24.CrossRefGoogle Scholar
  43. 43.
    Debbaneh MG, Levin E, Sanchez Rodriguez R, Leon A, Koo J, Rosenblum MD. Plaque-based sub-blistering dosimetry: reaching PASI-75 after two treatments with 308-nm excimer laser in a generalized psoriasis patient. J Dermatolog Treat. 2014;20Google Scholar
  44. 44.
    Choi KH, Park JH, Ro YS. Treatment of vitiligo with 308-nm xenon-chloride excimer laser: therapeutic efficacy of different initial doses according to treatment areas. J Dermatol. 2004;31(4):284–92.CrossRefGoogle Scholar
  45. 45.
    Taneja A, Trehan M, Taylor CR. 308-nm excimer laser for the treatment of localized vitiligo. Int J Dermatol. 2003;42(8):658–62.CrossRefGoogle Scholar
  46. 46.
    Alhowaish AK, Dietrich N, Onder M, Fritz K. Effectiveness of a 308-nm excimer laser in treatment of vitiligo: a review. Lasers Med Sci. 2013;28(3):1035–41.CrossRefGoogle Scholar
  47. 47.
    National Psoriasis Foundation, Drug pipeline. [cited 2014 Dec 18]. Available from: http://services.psoriasis.org/drug-pipeline/index.php.
  48. 48.
    National Psoriasis Foundation, Clinical Trials. [cited 2014 Dec 18]. Available from: http://www.psoriasis.org/research/drugs-in-development/clinical-trials.
  49. 49.
    NHS Choices, Vitiligo Clinical Trials. [cited 2014 Dec 18]. Available from: http://www.nhs.uk/Conditions/Vitiligo/Pages/clinical-trial.aspx.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Laura Jordan
    • 1
  • Summer Moon
    • 2
  • James M. Spencer
    • 3
  1. 1.Kansas City University Consortium, Tri-County Dermatology Residency ProgramCuyahoga FallsUSA
  2. 2.Dermatology Specialists of West FloridaSaint PetersburgUSA
  3. 3.Spencer Dermatology and Skin Surgery Center, Spencer Dermatology, Carillon Outpatient CenterSt. PetersburgUSA

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