Pulsed Dye, Fractional CO2, and Nd:YAG Lasers: A Comprehensive Evaluation in the Management of Nail Psoriasis

<b>Introduction:</b> Nail psoriasis poses a notable challenge due to its significant impact on patient's quality of life and its resistance to traditional treatments. Recent interest has focused on laser therapies, which offer targeted treatment by addressing the underlying inflammatory processes of the disease. This study evaluated the effectiveness and safety of pulsed dye laser (PDL), fractional CO2 laser, and Nd:YAG (neodymium-doped yttrium aluminum garnet) laser for nail psoriasis. <b>Methods:</b> In this randomized clinical trial, 40 patients with mild to moderate bilateral nail psoriasis were enrolled at Razi hospital. The participants were divided into four groups: Nd:YAG laser, PDL, fractional CO2 laser, and a control group treated with calcipotriol/betamethasone ointment. Each received four treatment sessions over four months. The Nail Psoriasis Severity Index (NAPSI) was used to evaluate effectiveness, while pain and satisfaction were assessed using the visual analog scale (VAS). Statistical significance was determined, with P<0.05 as the threshold. <b>Results:</b> The study found that PDL achieved the highest reduction in NAPSI scores, with a significant 62.4% decrease, followed by a 54.6% decrease with the fractional CO2 laser. In contrast, the Nd:YAG laser achieved a less notable 32.4% improvement, while the ointment control group showed a 15.9% decrease. Pain was least reported in the PDL group, and satisfaction scores were highest among these patients. The PDL and fractional CO2 lasers outperformed both the Nd:YAG laser and the topical therapy in effectiveness and patient comfort. <b>Conclusion:</b> PDL and fractional CO2 laser treatments are superior interventions for managing nail psoriasis, providing a significant improvement in NAPSI scores and better patient experiences compared to the Nd:YAG laser and topical ointment. These findings endorse the inclusion of laser therapy in management plans for nail psoriasis, suggesting further research into optimizing their use and potential combination with other therapies. <b>Trial Registration:</b> https://irct.behdasht.gov.ir/; identifier: IRCT20220723055530N4.