Objectives: • Become familiar with what the literature says about laser-assisted drug delivery in nail tissue
• Understand the risks and benefits of laser pretreatment in the topical management of nail disease
• Learn from our early-adopter experience with laser-assisted topical treatment of nail psoriasis
Introduction: Ablative fractional laser (AFL) pretreatment for topical therapy of nail disease is gaining ground. To investigate the safety and efficacy of this drug-device treatment approach, we conducted a randomized intra-patient controlled trial on laser-assisted Calcipotriol/Betamethasone Dipropionate (Cal/BD) foam treatment for psoriatic nail disease (PND) and provided an overview of the pertinent literature.
Materials / method: We included 11 patients with 144 psoriatic nails with an average NAPSI score (0-130) of 80. Half of each patient’s nails were randomized to receive AFL at baseline, week 6, and week 12. Patients were instructed to apply Cal/BD foam once daily for 24 weeks. Treatment response was monitored clinically supported with patient-reported outcome measures, optical coherence tomography (OCT), and patient-obtained photographs using a smartphone app.
For the systematic literature review, two investigators searched Pubmed for clinical trials on laser-assisted topical treatment of nail disease.
Results: Cal/BD achieved a reduction in NAPSI -68% (p=0.001), 60% decrease in quality of life burden, and a 43% reduction in OCT-assessed PND. AFL pretreatment achieved higher clinical (NAPSI -78%) and OCT-assessed (-46%) improvement than Cal/BD alone (NAPSI -58%, OCT -37%) but with no significant difference. Smartphone app images documented paronychia (n=1) and mild local skin reactions.
We identified 21 articles on AFL pretreatment for onychodystrophy (n=1), PND (n=3), and onychomycosis (n=17). The majority of studies (90.5%) concluded that AFL pretreatment is safe and effective.
Conclusion: While Cal/BD foam treatment substantially improved PND both with and without AFL, the available literature suggests that laser pretreatment could be a clinically relevant enhancement strategy for various types of topical therapies. Future studies on the impact of laser settings and choice of formulation may help optimize the efficacy of laser-assisted topical treatment of nail disease.
Disclosures
Did you receive any funding to support your research for this TOPIC?
Yes
Please specify entities (individual, company, society): LEO Pharma
Were you provided with any honoraria, payment or other compensation for your work on this study?
No
Do you have any financial relationship with any entity which may closely compete with the medications, materials or instruments covered by your study?
No
Do you own or have you applied for any patents in conjunction with the instruments, medications or materials discussed in your study?
No
This work is presented thanks to the support of: LEO Pharma