Excimer Laser Therapy for Hairline Psoriasis

A Useful Addition to the Scalp Psoriasis Treatment Algorithm

Jillian W. Wong, BA; Faranak Kamangar, BSc; Tien V. Nguyen, BA; John Y.M. Koo, MD

Disclosures

Skin Therapy Letter. 2012;17(5) 

In This Article

Abstract and Introduction

Abstract

Psoriasis is a chronic, inflammatory skin condition with negative impacts both physical and psychological. Scalp psoriasis, especially around the hairline, can cause significant impairment in quality of life due to its visibility. Options for treatment of facial psoriasis, including hairline involvement, are the use of low potency topical steroids, calcineurin inhibitors, and vitamin D analogues. Though the use of excimer laser for scalp psoriasis has been reported, there are no cases or studies specifically examining excimer laser phototherapy for the treatment of hairline psoriasis. We present a case of rapid improvement of hairline psoriasis using a regimen of 308 nm excimer laser with clobetasol spray and recommend an algorithm for the optimal treatment of scalp psoriasis utilizing currently available antipsoriatic therapies.

Introduction

Psoriasis is an inflammatory skin disease affecting approximately 2.6% of the U.S. population.[1] Psoriasis tends to remain stable throughout the patient's lifetime or become gradually more widespread. It is associated with a high degree of morbidity, as well as having a negative impact on the lives of patients physically, psychologically, socially, and occupationally.[2,3] As it is a chronic condition, psoriasis often requires lifelong treatment.

Patients suffering from psoriasis have relatively high rates of depression and often report stigmatization, embarrassment, and self-consciousness.[4] Plaques along the hairline and retroauricular regions are visible and resistant to therapy. Treatment of scalp psoriasis with laser has been reported, but this modality presents challenges due to the difficulty of penetration of photons through hair.[5] Hence, such a limitation may discourage the use of excimer laser for scalp psoriasis. It must be noted, however, that because the forehead, hairline, and retroauricular areas are not entirely covered by hair, treatment with laser is a clearly viable option.

Targeted ultraviolet B (UVB) excimer laser phototherapy is one of the most cutting-edge advances in phototherapy. The xenon chloride laser produces a 308 nanometer (nm) monochromatic beam of light that is efficacious for the treatment of psoriasis.[6] In contrast to traditional phototherapy, the UVB laser treats targeted areas while sparing the non-involved skin. Psoriatic plaques can tolerate increased dosimetry compared with non-involved skin, and a supra-erythmogenic dose (multiple times above the minimal erythema dose [MED]) can be delivered, resulting in faster clearance than with traditional UVB phototherapy.[6,7] We first present a case of rapid improvement and maintenance of hairline psoriasis treated with 308 nm excimer laser and clobetasol spray, followed by a discussion of current treatment options, and, finally, offer a recommended algorithm for the treatment of scalp psoriasis.

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