الفهرس 
PsoriasisOnly 14 pages are availabe for public view
Abstract
Psoriasis is a chronic, inflammatory, immune-mediated, polygenic disease, resulting from interaction between genetic predisposition and several triggering factors. It may involve the skin, joints, and nails, either alone or in combination. It is characterized by periods of remission and relapse. Psoriasis is associated with several co-morbidities including: decreased quality of life, depression, increased cardiovascular risk, and type 2 diabetes mellitus.
Nail psoriasis can affect 10-55% of psoriasis patients. The lifetime incidence of nail involvement in psoriatic patients is estimated to be 80–90%. Nail affection may be considered as a predictor of future psoriatic joint damage. Psoriasis of the nails has a significant adverse effect on patients‟ quality of life due to pain and aesthetic concerns. It manifests as: pitting, crumbling, leukonychia, nail bed discoloration, onycholysis, subungual hyperkeratosis and abnormalities of the nail plate. Psoriasis of the nails tends to be persistent and refractory to therapy, making its management challenging and distressing for patients and physicians. The treatments of nail psoriasis can be topical treatments such as corticosteroids, calcipotriol, anthralin, tazarotene, fluorouracil, and cyclosporine; intralesional corticosteroid injections; phototherapy; photochemotherapy or systemic therapies such as cyclosporine, methotrexate, and etretinate. Also, biologics have shown efficacy in treating refractory nail psoriasis.
Pulsed Dye Laser (PDL), which is based on selective photothermolysis, has been broadly used for treating cutaneous vascular lesions, as well as several nonvascular conditions including acne, warts, and scars. PDL has been used for treating psoriasis because of the highly vascular nature of psoriatic lesions, and it has shown high efficacy. Also, over the past few years, studies were done investigating the efficacy of PDL in treating nail psoriasis. PDL was reported effective, safe, and well tolerated.
In the present study, our main objective was to further prove the efficacy of PDL in the treatment of nail psoriasis in a randomized, controlled, prospective, single-blinded study. Twenty patients with bilateral fingernails‟ psoriasis were enrolled in the present study. Half the affected nails were treated with PDL once monthly sessions for 6 months; and the other half were left untreated as the control arm of the study. The clinical outcome was assessed by NAPSI score and photos. Follow up was done 1 month after the last session. The PDL-treated nails showed marked clinical improvement. The decrease in the matrix, nail bed, and total NAPSI scores in the treated nails was highly statistically significant (P= 0.0000) compared to pre-treatment scores and to control nails‟ scores. So, PDL is a safe and effective treatment for nail psoriasis.