The 308 nm excimer laser has been the gold standard for psoriasis phototherapy, says Dr. Nestor.
“It's effective,” he adds, “but there are issues with it including skin burning.”
Blistering may help clear psoriasis faster, according to Dr. Nestor, although it can result in hyperpigmentation, which is usually reversible (most fades upon completion of therapy).
For physicians who frequently treat psoriasis with light-based devices, he says, excimer laser increasingly may be supplanted by lasers such as the 650 ms Nd:YAG (LightPod Neo, Aerolase). In a 15-patient bilateral comparison study by Dr. Nestor, this laser provided equivalent efficacy to excimer on the trunk and limbs. After 15 treatments, average overall Modified Psoriasis Area and Severity Index (mPASI) scores for both lasers fell from approximately 2.4 at baseline to 1.5.2
Because the 650 ms Nd:YAG laser uses a different mechanism of action than does excimer laser, he says, the former does not cause burns.
“There is potential for utilizing this therapy much more in the future, especially in areas such as the palms and soles, where excimer appears to be less effective,” Dr. Nestor notes.
Dr. Nestor was a paid researcher in the 650 µs Nd:YAG laser study but reports no relevant financial interests.
1. Mark S Nestor MD. “Lasers and Psoriasis: The Future of Phototherapy,” South Beach Symposium. February 8, 2019.
2. Nestor MS, Fischer D, Arnold D. Randomized, investigator-blinded study to compare the efficacy and tolerance of a 650-microsecond, 1064-nm YAG laser to a 308-nm excimer laser for the treatment of mild to moderate psoriasis vulgaris. J Drugs Dermatol. 2020;19(2)176-183. Doi:10.36849/JDD.2020.4769.