Efficacy of pulsed dye laser plus topical tazarotene versus topical tazarotene alone in psoriatic nail disease: A single-blind, intrapatient left-to-right controlled study

Background Nail psoriasis is difficult to treat. The efficacy of pulsed dye laser (PDL) therapy for nail psoriasis has been reported in non-placebo controlled studies. Objective To evaluate the efficacy and safety of PDL with topical retinoid in the treatment of nail psoriasis. Methods The study was an intrapatient, left-to-right controlled trial of PDL in 25 patients with recalcitrant, bilateral fingernail psoriasis recruited between February 2011 and August 2011. We included two groups of patients: (1) patients with severe psoriasis who were receiving stable systemic therapy (phototherapy and systemic medication); (2) patients with mild psoriasis who were not receiving systemic therapy. One hand received the experimental treatment (PDL and tazarotene 0.1% cream) and the other, the control treatment (tazarotene 0.1% cream). All five fingernails of the experimental hand were treated with 595-nm PDL once a month for 6 months. Assessments included the modified Nail Psoriasis Severity Index (NAPSI) at baseline, 3, and 6 months, the Physician's Global Assessment at 3 and 6 months, the patient's global assessment, and adverse events. Results Nineteen patients completed the 6-month protocol. The mean decrease in modified NAPSI score from baseline to 6 months was significantly more after the experimental treatment than the control treatment. Physician's global assessment showed significantly higher percentage of patients had ≥75% improvement at 6 months in the experimental group than the control group (31.6% vs. 5.3%, P = 0.045). Scores on the patient's global assessment were significantly higher in the experimental group than the control group (P < 0.001). Conclusion PDL plus topical tazarotene 0.1% cream is an effective and safe therapy in the treatment of nail psoriasis.