After 4 treatments with a pulsed dye laser, this 14 year-old girl had 95% clearance of stubborn psoriasis on her hands and feet. The psoriasis had been there for 6 years. Photographs used with permission of the Journal of the American Academy of Dermatology. All photographs were published in the Journal of the American Academy of Dermatology, Vol. # 54, de Leeuw J, Tank B, Bjerring PJ, et al, “Concomitant treatment of psoriasis of the hands and feet with pulsed dye laser and topical calcipotriol, salicylic acid, or both: A prospective open study in 41 patients,” 266-71. Copyright Elsevier (2006).

Number of treatments: This type of phototherapy requires fewer treatment sessions than other types of phototherapy. If the psoriasis responds to laser treatment, between 4 and 10 treatment sessions typically clear the targeted psoriasis. This will vary with the type of laser and the psoriasis.

How long clearing lasts: This is a newer treatment option, so there is limited information about how long remission lasts. In one study, the pulsed dye laser was used to treat psoriasis on the hands and feet. To help the laser light penetrate the psoriasis, patients also applied a topical (applied to the skin) psoriasis medicine between laser treatments. Those who had a good or very good response (76%) also saw clear skin for quite some time. The average remission time was 11 months.

More studies have been conducted with the excimer laser. One study found that the average remission time is 3 to 4 months after the last treatment. Another study suggests that longer remission is possible. This study found that after 1 year, most (26 of 28) patients were still in remission.

Side effects: Treatment with a pulsed dye laser will cause bruising, and this is expected. A pulsed dye laser actually penetrates the skin and destroys the blood vessels that allow the psoriasis to form. Because this laser produces visible light (not UV light), the pulsed dye laser does not increase the risk of skin aging or skin cancer.

Other possible side effects from laser treatment (pulsed dye and excimer) are temporary redness, swelling, and a burning sensation after treatment. In a few people, blisters or burns develop. Some see darkening of the treated skin. There also is a small risk of scarring.

If you are considering laser treatment
People considering laser treatment should know that many states do not regulate who can perform a procedure with a laser or other light source. Since lasers and other light treatments carry potential side effects, always ask who will perform the procedure. The American Academy of Dermatology recommends that laser procedures be performed by a board-certified dermatologist or under this doctor’s direct supervision.

It also is important to know that while laser treatment can effectively treat a small area of psoriasis, it cannot treat widespread psoriasis.

References:
American Academy of Dermatology. “American Academy of Dermatology Issues New Guidelines for the Management of Psoriasis With Ultraviolet Light Therapy.” News release issued October 22, 2009. Available at www.aad.org/media/background/news/
Releases/American_Academy_of_Dermatology_Issues_New_Guideli4/. Last accessed January 25, 2010.

de Leeuw J, Tank B, Bjerring PJ et al. “Concomitant treatment of psoriasis of the hands and feet with pulsed dye laser and topical calcipotriol, salicylic acid, or both: a prospective open study in 41 patients.” Journal of the American Academy of Dermatology February 2006; 54: 266-71.

Menter A, Korman NJ, Elmets CA et al. “Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy.” Journal of the American Academy of Dermatology January 2010; 62: 114-35.

Morison WL, Atkinson DF, Werthman L. “Effective treatment of scalp psoriasis using the excimer (308 nm) laser.” Photodermatology Photoimmunology & Photomedicine August 2006; 22: 181-3.