In age of biologics, phototherapy, lasers remain valuable for psoriasis
MIAMI BEACH, Fla. — Here at the South Beach Symposium, meeting chair Mark S. Nestor, MD, PhD, reviewed current and future treatment options for psoriasis.
“Psoriasis is an autoimmune inflammatory skin disease that is associated with increased vascularity,” Nestor, who is a dermatologist in the department of dermatology and cutaneous surgery and the division of plastic surgery at the University of Miami Miller School of Medicine, said during his presentation. “The many treatment options for psoriasis include topicals, orals, injectables, light and laser therapies.”
Phototherapy has been widely used for the treatment of psoriatic lesions on the trunk, scalp, arms, legs and nails for decades, according to Nestor.
“Phototherapy is an important component of treatment, even in the age of biologics. This light and laser therapy appears to modulate the local immune environment of the psoriasis plaque and reduces small blood vessels in cases of vascular lasers,” he said. “Phototherapy down regulates the Th17 pathway, increases regulatory T cells and restores regulatory T cell function via the up regulation of FOXP3, among other things.”
Other effective treatments for psoriasis include targeted light sources and lasers, such as the excimer laser, pulsed dye laser, low level laser, light-emitting diodes (LED) and short pulse YAG lasers.
“Low level laser therapy is more widely used in clinical dermatology for acne, alopecia, cutaneous pain, wound healing and burns,” Nestor said. “However, wavelengths that are optimal for psoriasis include blue light — reduces proliferative activity of keratinocytes, modulates T cell immune responses and improves plaque psoriasis — and red light — deeply penetrates skin to about 6 mm, stimulates mitochondrial activity and modulates cytokine release from macrophages to reduce topical inflammation.”
Nestor referenced a study in which he and colleagues sought to compare the safety and efficacy of a 650 microsecond, 1064 nanometer, pulsed YAG laser vs. a 308 nm Excimer laser for the treatment of psoriatic plaque located on the trunk and limbs of 15 patients with mild to moderate psoriasis vulgaris.
“We essentially found equivalence between the two lasers during the first 15 weeks of treatment,” Nestor said. “Both lasers significantly reduced the appearance of psoriatic plaque and there were no adverse effects observed throughout the treatment course. Of note, there is insurance reimbursement for laser therapy for psoriasis and is, for the most part, quite reasonable.” – by Jennifer Southall
Nestor MS. Light and Laser Therapies for Psoriasis. Presented at: South Beach Symposium; Feb. 6-9, 2020; Miami.
Disclosures: Nestor reports relationships with numerous companies, including Allergan, Bayer Healthcare and Bioderma.