A comparative study of fractional CO2 laser combined with topical methotrexate versus fractional CO2 laser combined with topical [calcipotriol + betamethasone] in the treatment of nail psoriasis

Abstract

Nail psoriasis is a distressing clinical condition as it is known that psoriasis on visible areas of the skin, such as the face, hands and nails, may have a substantial negative impact on physical, psychological, and social dimensions of quality of life. The additional negative consequences of nail involvement in psoriasis are pain, inability to grasp small objects, tie shoe laces or button clothes, and cause an altered sense of fine touch. The management of nail psoriasis has been challenging particularly when the nail involvement is the only manifestation of the disease. Low penetration of the topical medications and slow growth rate of the nails are the main factors for this difficulty. Moreover, most of the therapies require prolonged treatment and continuity, sometimes with side effects and/or disappointing results. Obviously, it may have a negative impact on patient's compliance, motivation, and quality of life. In the current study we aimed to evaluate, compare the efficacy, safety and the side effects of methotrexate and calcipotriol plus betamethasone two compound formula when applied topically on psoriatic nails after their exposure to fractional co2 laser to facilitate the drug delivery through nail plates. We included 20 patients with multiple psoriatic nails (fingers or toes) in both body sides and each side was treated with one of the above mentioned medications and compared to the other side.