Nail Psoriasis Clinical Trial
Official title:
Efficacy of Combined Fractional Carbon Dioxide Laser and Topical Tazarotene in the Treatment of Psoriatic: Nail Disease a Single-blind, Intrapatient Left-to-right Controlled Study.
Nail psoriasis has a high incidence amongst patients with psoriasis.It is estimated to affect
80% of psoriatic patients at some time during their lives and has a significant adverse
influence on their quality of life.
Treatment of nail psoriasis is disappointing, as it is refractory to treatment, with
conventional therapies often having little effect.
The characteristic lesions affecting the nail present as 'oil drop' discoloration, splinter
haemorrhages, subungual hyperkeratosis, and onycholysis in the nail bed or pitting,
leuconychia, erythema of the lunula and crumbling in the nail matrix.Diagnosis is customarily
made by patient history and physical examination, though it may be necessary to rule out
onychomycosis as a differential diagnosis.
The nail psoriasis severity index has recently been reported as a possible reproducible,
objective, and simple tool for clinical assessment of psoriatic nail disease.
The modified target nail psoriasis severity index has been proposed for target nail
assessment which would give a degree of gradation for each parameter of 0 to 3 (0 = none, 1 =
mild, 2 = moderate, and 3 = severe) in each quadrant.The topical therapies include topical
and intralesional corticosteroids , topical vitamin D3 analogues (calcipotriol) , topical
tacrolimus and tazarotene[8]. The efficacy of these topical therapies in nail disease is
limited mainly by the impenetrability or low penetrability of the nail and nail matrix. In
patients with nail psoriasis that is resistant to topical therapies, conventional systemic
therapies (e.g., phototherapy, retinoids, cyclosporine, methotrexate) have been shown to be
partially effective. More recently, biological therapies (e.g., infliximab, adalimumab,
alefacept, etanercept) have proven efficacy in psoriasis and psoriatic arthritis, and some
are effective in treating nail disease in patients with psoriasis .
Previous study proved successful treatment of onychodystrophy using fractional carbon dioxide
laser with topical steroid. Fractional Carbon dioxide laser might be an effective therapy for
nail psoriasis due to its ablative ability which produce microscopic holes that perhaps
improve topical drug delivery. Moreover it was hypothesized that tissue ablation and
remodelling process stimulate rejuvenation of the abnormal nail bed.The investigators
hypothesized that the combination of Fractional carbon dioxide laser and topical tazarotene
treatment will have a higher therapeutic effect on nail psoriasis through multiple mechanism.
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