excimer laser psoriasis protocol

Spencer JM, Hadi SM. excimer laser. The 308 nm excimer laser has the. After 5weeks, 1session per week, the condition significantly improved (Fig. It has a range of efficacies depending on the protocol used with several different treatment protocols, including the induration protocol, the minimal erythema dose protocol, and the newer minimal blistering dose protocol. Gupta SN, Taylor CR. It is important to consider the patient’s skin type, as this will further dictate the appropriate dosimetry as well as predict the degree of erythema and blistering that patients may experience. The absorption of 308 nm wavelength induces DNA breakage, upregulation of the tumor suppressor gene p53, and subsequent reduction of proto-oncogene Bcl-2, leading to cell cycle arrest in keratinocytes and T lymphocytes.1 This breaks the positive feedback loop and halts the psoriatic disease cycle created by the activated T lymphocytes. 1992;23:117–133. Even psoriasis that has been refractory to systemic treatments have been demonstrated to show improvement with the excimer laser. Feldman SR, Mellen BG, Housman TS, et al. All studies determined the initial treatment dose using either the minimal erythema dose (MED) or induration. EXCIMER 308 Monochromatic UVB light therapy for Psoriasis and Vitiligo skin diseases. Epub 2019 Jul 6. Where these systemic agents attempt to modulate the immune system and the immune pathway leading to the development of psoriasis, the excimer laser seeks to ultimately eliminate the T cells involved in the pathophysiology altogether, thus addressing all pathways involved at the cutaneous level with no reported systemic side effects. All patients improved, and 49% of the patients cleared completely. The three main protocols used for the treatment of psoriasis include: the minimal erythema dose (MED) protocol, the induration protocol, and the newer minimal blistering dose (MBD) protocol.30, The MED is established by first testing healthy, non-psoriatic skin and determining the minimal dose (millijoules) that causes a well-demarcated, minimally erythematous pink macule.33 Typically, with this method, the patient the will require two initial visits to calibrate the MED, with a total of 12 treatments sessions thereafter to reach PASI-75.18 Information pertaining to exact treatment dosages in terms of millijoules is limited, as studies only report cumulative doses at the end of the patient treatment course. Park et al report a patient who was treated with etanercept monotherapy for 12 weeks and etanercept combined with narrowband UVB phototherapy three times weekly for an additional 12 weeks that failed to achieve an optimal treatment response. Furthermore, Kagen et al demonstrated that very high doses of excimer laser treatment in psoriatic lesions reduced the numbers of pathogenic memory/effector T cells infiltrating lesional epidermis and dermis.7, While the importance of the excimer laser in the treatment of psoriasis will be discussed, it is interesting to note the origins of the excimer laser. 2004;140:518–520. Although the PDL laser performed better than the excimer laser for the treatment of nail psoriasis, 38% of hands treated with the excimer laser achieved NAPSI-50, an improvement of at least 50% in nail psoriasis.39, Palmoplantar pustular psoriasis is another subtype of psoriasis that can often be difficult to treat. The three main protocols that were identified were the MED protocol, the Induration protocol, and the MBD protocol. The patient was then treated for 12 days following the initial treatment at a sub-blistering does of 800 mJ. Single administration of lesion-limited high-dose (TURBO) UVB using the excimer laser: clinical clearing in association with apoptosis of epidermal and dermal T cell subsets in psoriasis. The conclusion was that psoriasis required 7 to 11 treatment sessions to clear. As previously postulated, the 308 nm excimer laser plays a role in melanocyte re-migration and thus has been shown to be beneficial in the treatment of vitiligo and hypopigmented disorders. The major side effects identified were erythema, tenderness, and blistering at the sites of treatment. A total of four studies were found using the 308-nm excimer laser for OLP. Applications of the excimer laser: a review. Photodermatol Photoimmunol Photomed. Treatment of plaque-type psoriasis with the 308 nm excimer laser in combination with dithranol or calcipotriol. Malakouti et al demonstrated the efficacy of the excimer laser in treating a 63-year-old Asian male with moderate to severe plaque psoriasis that had previously failed treatment with 28 weeks of ustekinumab therapy. Photodermatol Photoimmunol Photomed. 1983;96(8):710–715. The 308 nm excimer laser is an effective therapy for psoriasis regardless of the method used to determine initial dosage, dose fluency, or number of treatments. Seven prospective studies were found describing the excimer efficacy for psoriasis. Lasers Surg Med. The 308 nm excimer laser was initially studied for the treatment of moderate plaque psoriasis by Bonis et al in 1997. 308-nm excimer laser for the treatment of scalp psoriasis. Glossop ND, Jackson RW, Koort HJ, Reed SC, Randle JA. The Lancet. Results: Sevrain M, Richard MA, Barnetche T, et al. Epub 2020 Feb 14. Abrouk M, Levin E, Brodsky M, Gandy JR, Nakamura M, Zhu TH, Farahnik B, Koo J, Bhutani T. Psoriasis (Auckl). Loughran M. President Obama honors IBM scientists with National Medal Of Technology And Innovation for Breakthrough That Enabled LASIK Surgery. The United States Federal Drug Administration approved the XTRAC (Excimer) laser for psoriasis therapy in 2009. 2005;22:161–165. Finally, use of clobetasol spray and ointment in conjunction with the excimer laser resulted in a safer side effect profile, as well as improved clearance of lesions in the long term.30. Figure 2 Plaque type psoriasis on lower extremity after eight treatments with excimer laser according to MED protocol. Fluency ranged from 0.5 MED (low) to 16 MED (high); one study demonstrated that medium to high fluencies yielded better improvement in fewer number of treatments. It became clear in assessing these various protocols that the most efficacious protocol was the MBD protocol, in which patients were treated all the way up to a sub-blistering starting dose, and followed accordingly with dose modulation as needed. When compared to the narrow band UVB laser, the 308 nm laser has an increased induction rate of T-cell apoptosis.1 Compared with traditional narrow band UV therapy, the excimer laser requires on average less number of treatment sessions and thus a smaller amount of cumulative UVB exposure. Because XTRAC delivers a highly targeted, therapeutic beam of UVB light only to areas of the skin affected by psoriasis, healthy skin surrounding the lesions stays that way. If clearance in the fastest possible time is the goal, the MBD protocol would be the best option. Of the 21 patients who completed the protocol, 76% achieved at least PASI-75 by week 12. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. J Lasers Med Sci. Complete remission of cutaneous T-cell lymphoma has been demonstrated with biweekly excimer treatments. 2012;28:133–136. The search results were included if they contained information pertaining to excimer laser and psoriasis treatment and description of the safety, efficacy, and patient acceptability of the treatment. This laser focuses a single band of ultraviolet B (UVB) light on psoriasis sores. Ardeleanu V, Sabina Radaschin D, Tatu AL. •  Top, © Copyright 2021  •  Dove Press Ltd   An optimal therapeutic dose protocol with excimer laser for the treatment of plaque psoriasis yielded more effective dosing in fewer treatment sessions, … 2002;46:900–906. Efficacy of the 308-nm excimer laser for treatment of psoriasis: results of a multicenter study. The excimer laser in orthopaedics. Exp Ther Med. Treatment with the excimer laser was twice weekly, with a mean of 21 total treatments. Excimer laser treatment is highly effective in psoriasis, another T cell–mediated disorder that shares many immunologic features with AA. This suggests that not only can the excimer laser be used in combination therapy, but it may even be more efficacious to utilize the laser in combination.43, Although the excimer laser is often not a first-line treatment for psoriasis patients, it can be useful in combination or in the treatment of patients who are refractory to other treatments (Figure 4). Arch Dermatol. More specifically, inflammatory cells such as dendritic cells, macrophages, and CD3+ T cells and CD8+ T cells are detected in the dermis, whereas neutrophils and some CD3+ T cells and CD8+ T cells are detected in the epidermis.5 The aforementioned synopsis of the pathogenesis and pathophysiology of psoriasis will be crucial for the understanding of the mechanism of action of the excimer laser. J Dermatolog Treat. open access to scientific and medical research. UK VAT Group: GB 365 4626 36. Frentzen M, Koort HJ, Thiensiri I. Excimer lasers in dentistry: future possibilities with advanced technology. This Xe2 excimer laser emitted at 172 nm, and with this a new class of lasers were invented.8 The first applications of the excimer lasers were within various research laboratories, including Avco Everett Research Laboratory, Sandia Laboratories, the Northrop Research and Technology Center, and the United States Government’s Naval Research Laboratory.9, The initial application of the excimer laser in the medical field emerged in 1983 from the collaboration of Rangaswamy Srinivasan and the ophthalmic surgeon Stephen Trokel.10,11 This collaboration led to the development of LASIK surgery procedure, which has been performed over 28 million times worldwide as of 2009. Available from https://www-03.ibm.com/press/us/en/pressrelease/39829.wss. Starting dose was established at 1500 mJ, and several other advanced features are temporarily.!, Lozano AM, Murphy F, Gottlieb a mi ld, moderate and eve N but. Sanchez Rodriguez R, Srinivasan R, Srinivasan R, Leon a, et al in 1997 Bonis. 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