Application of therapeutic physical factors in the therapy of psoriatic onychodystrophy

Background: One of the common clinical manifestations of psoriasis is nail plate damage, leading to psoriatic onychodystrophy (PОD). PОD is often accompanied by severe pain syndrome, causing difficulties in wearing shoes or socks and performing daily household tasks, which leads to a decrease in quality of life and contributes to the development of anxiety and depression. Studies on PОD treatment have demonstrated the effectiveness of non-pharmacological approaches, particularly pulsed dye laser (PDL) therapy and medium-frequency pulsed currents (Darsonval therapy), which promote regression of clinical symptoms. Aim: To assess the clinical efficacy of a comprehensive treatment approach incorporating PDL and Darsonval therapy in patients with psoriatic onychodystrophy. Materials and methods: A prospective, controlled, randomized study was conducted, including 110 patients with PОD, who were randomly assigned to four groups using simple fixed randomization. Group 1 (Control, n=27): received only basic therapy (BT) consisting of topical application of calcipotriol ointment. Group 2 (Comparison Group 1, n=28): received three courses of Darsonval therapy in addition to BT Group 3 (Comparison Group 2, n=28): received 5–6 sessions of PDL therapy, performed at one-month intervals, in addition to BT. Group 4 (Main Study Group, n=27): received both Darsonval therapy and PDL therapy in combination with BT. The clinical assessment included the frequency of nail matrix and nail bed lesions, as well as the Nail Psoriasis Severity Index (NAPSI) and the Dermatology Life Quality Index (DLQI)scores. Results: NAPSI assessment revealed widespread involvement of the nail bed and matrix among patients. The initial DLQI score was 23.6 points, indicating a significant negative impact of nail disease on patients’ daily lives. All treatment groups demonstrated clinical improvement, but the extent of symptom regression depended on the treatment regimen. Additional therapeutic physical factors further enhanced effectiveness, with the combined use of Darsonval therapy and PDL therapy producing the best clinical outcomes. Conclusion: Incorporating physical therapy modalities into the standard treatment regimen for psoriatic onychodystrophy significantly improves clinical effectiveness. The combined application of pulsed dye laser and Darsonval therapy achieves the greatest regression of clinical manifestations and substantial improvements in patients’ quality of life.