Nail Psoriasis
Conditions
Keywords
psoriasis, nail, laser, excimer, treatment
Brief summary
Psoriasis is a common skin disease, which affects 2-3% of the population. Up to two third of patients with psoriasis develop nail changes. These visible changes can be painful and disabling and are associated with social stigma. Most topical treatments are only partially effective. Systemic treatments can have serious side effects. Excimer laser is a form of targeted ultraviolet light therapy that has been successfully used to treat isolated psoriatic plaques on difficult to treat areas such as scalp or palms. The purpose of this study is to investigate efficacy of excimer laser for treatment of fingernail psoriasis. Sixteen patients with stable fairly symmetric fingernail psoriasis will be enrolled. After obtaining informed consent, an investigator will evaluate the severity of nail psoriasis in each hand using an objective score, called Modified Nail Psoriasis Severity Index (mNAPSI). In a random fashion, one hand will be treated with excimer laser and the other hand will receive sham treatment. During the treatments, patients will wear protective eyewear that does not permit them to see which hand receives active treatment and which hand receives sham treatment. Patients will be treated twice a week for 8 weeks. At weeks 8, 12, and16 the investigator who is blinded to the treatment assignments will re-evaluate the fingernails using mNAPSI score. Mean change from baseline mNAPSI score at weeks 8, 12, and 16 in hands treated with excimer compared to hands treated with sham will be measured. We will also measure patient's assessment of severity of nail disease and the pain or any adverse events associated with laser treatments. Given the slow growth rate of fingernails, the final evaluations will be performed at week 16. In summary, this is the first controlled study to evaluate efficacy of excimer laser in fingernail psoriasis. If found to be effective, excimer laser could be used as a safe, locally administered treatment for recalcitrant nail psoriasis.
Interventions
DEVICE308 nm excimer laser
Biweekly treatments with 308 nm excimer laser for a total of 8 weeks
DEVICESham laser
Sham laser treatment to the control side biweekly for a total of 8 weeks.
Sponsors
American Society for Dermatologic Surgery
University of Utah
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Must give written informed consent. * Must be at least 18 years old. * Must have been diagnosed with stable fingernail psoriasis. * Must have fairly symmetric fingernail psoriasis in right and left hand with similar modified NAPSI scores in right and left hand target nails. Target nail is defined as the fingernail with highest modified NAPSI score. * Must have active fingernail psoriasis, defined as a target fingernail matrix NAPSI score of at least 2 and modified NAPSI score from a combination of crumbling, onycholysis and pitting at least 2. • * No changes in the systemic therapy or nail directed topical therapy during the 16 week study period.
Exclusion criteria
* Subjects unable to tolerate frequency of visits. * History of intolerance to or worsening of psoriasis with ultraviolet light. * Current use of known photosensitizing medications. * History of Fitzpatrick Type I skin, photosensitivity, or keloid formation. * Any new systemic psoriasis therapy including biologics, conventional systemic immunomodulators, phototherapy, or nail directed topical therapy for the last 3 months prior to enrollment. * Any other condition that in the eyes of the investigator will disqualify patient from the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Modified NAPSI Score (Nail Psoriasis Severity Index) | at 16 weeks | This is an instrument that scores nail psoriasis severity. Severity for each nail is measured on a scale of 0-13, where crumbling, pitting, onycholysis and oil spots together are each graded 0-3, and other features (leukonychia, splinter hemorrhages, hyperkeratosis, and red spots in lunula) are scored 0 (absent) or 1 (present). Higher score indicates more severe nail psoriasis with 13 being the most severe and 0 being no nail disease present. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient Assessment of Nail Psoriasis Activity | at 16 weeks | this is a subjective patient reported scale, 0-100, where 100 is the most severe global assessment of the patient's nail psoriasis, and 0 is clear (no nail disease present). |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| All Study Participants all study participants received 308 nm excimer laser treatment to one hand and sham laser to the other hand.
308 nm excimer laser: Biweekly treatments with 308 nm excimer laser for a total of 8 weeks | 8 |
| Total | 8 |
Baseline characteristics
| Characteristic | All Study Participants |
|---|---|
| Age, Continuous | 45 years |
| Sex: Female, Male Female | 1 Participants |
| Sex: Female, Male Male | 7 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 7 | 0 / 7 |
| other Total, other adverse events | 0 / 7 | 0 / 7 |
| serious Total, serious adverse events | 0 / 7 | 0 / 7 |
Outcome results
Primary
Modified NAPSI Score (Nail Psoriasis Severity Index)
This is an instrument that scores nail psoriasis severity. Severity for each nail is measured on a scale of 0-13, where crumbling, pitting, onycholysis and oil spots together are each graded 0-3, and other features (leukonychia, splinter hemorrhages, hyperkeratosis, and red spots in lunula) are scored 0 (absent) or 1 (present). Higher score indicates more severe nail psoriasis with 13 being the most severe and 0 being no nail disease present.
Time frame: at 16 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Active | Modified NAPSI Score (Nail Psoriasis Severity Index) | 6.3 units on a scale | Standard Deviation 1.8 |
| Sham | Modified NAPSI Score (Nail Psoriasis Severity Index) | 6.0 units on a scale | Standard Deviation 1.3 |
Secondary
Patient Assessment of Nail Psoriasis Activity
this is a subjective patient reported scale, 0-100, where 100 is the most severe global assessment of the patient's nail psoriasis, and 0 is clear (no nail disease present).
Time frame: at 16 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Active | Patient Assessment of Nail Psoriasis Activity | 58.6 units on a scale | Standard Deviation 33 |
| Sham | Patient Assessment of Nail Psoriasis Activity | 55.4 units on a scale | Standard Deviation 24.3 |