A Comprehensive Evaluation of the Efficacy of Intense Pulsed Light and Neodymium-doped Yttrium Aluminum Garnet Laser Treatments in Nail Psoriasis

Introduction: Nail psoriasis significantly impairs quality of life and remains therapeutically challenging due to the limited efficacy of treatments. Objectives: To compare the clinical efficacy and safety of Nd:YAG laser and intense pulsed light (IPL) therapy in nail psoriasis using total and modified NAPSI scores, clinical and dermatoscopic findings. Methods: This retrospective study evaluated 101 nails from 14 patients treated with either IPL (N=66) or Nd:YAG laser (N=35). Treatments were administered every 4–6 weeks for 2–8 sessions. Nail psoriasis severity was assessed at baseline and at six months using NAPSI, mNAPSI, and dermatoscopic and clinical features. Results: PL therapy significantly reduced matrix (3.48→1.94), nail bed (3.47→1.33), total NAPSI (6.95→3.27), and mNAPSI (9.21→3.92) scores (P<0.05). Nd:YAG laser treatment also resulted in significant improvements in matrix (3.54→2.20), nail bed (3.77→1.97), total NAPSI (7.31→4.17), and mNAPSI (8.83→5.23) scores (P<0.05). In our cohort, IPL appeared to have a more favorable impact on mNAPSI, pitting, salmon patches, subungual hyperkeratosis, and splinter hemorrhages, while Nd:YAG tended to provide greater improvement in leukonychia (P<0.05). No recurrence or adverse event was observed during the 12-month follow-up period. Conclusions: Both IPL and Nd:YAG laser therapies are safe and effective options for nail psoriasis. IPL showed superior efficacy in nail bed involvement, whereas Nd:YAG may be preferred for leukonychia. Laser-based treatments are promising alternatives in refractory cases.