308nm Excimer Laser for Treatment of Fingernail Psoriasis

NCT ID: NCT02168933

Last Updated: 2019-09-18

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

8 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-01-31

Study Completion Date

2015-01-31

Brief Summary

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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.

Detailed Description

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Conditions

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Nail Psoriasis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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active excimer laser

308 nm excimer laser treatment: treatment with the laser by a dose protocol with increasing output.

Group Type EXPERIMENTAL

308 nm excimer laser

Intervention Type DEVICE

Biweekly treatments with 308 nm excimer laser for a total of 8 weeks

Sham excimer laser

Sham 308 nm excimer laser treatment: laser dose was administered with a cap that blocks all active UV passing through the device, therefore is a placebo, but because the procedure is the same, maintains a blind.

Group Type SHAM_COMPARATOR

Sham laser

Intervention Type DEVICE

Sham laser treatment to the control side biweekly for a total of 8 weeks.

Interventions

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308 nm excimer laser

Biweekly treatments with 308 nm excimer laser for a total of 8 weeks

Intervention Type DEVICE

Sham laser

Sham laser treatment to the control side biweekly for a total of 8 weeks.

Intervention Type DEVICE

Eligibility Criteria

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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.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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American Society for Dermatologic Surgery

OTHER

Sponsor Role collaborator

University of Utah

OTHER

Sponsor Role lead

Responsible Party

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Kristina Callis

M.D.

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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University of Utah, Department of Dermatology

Salt Lake City, Utah, United States

Site Status

Countries

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United States

References

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Augustin M, Herberger K, Hintzen S, Heigel H, Franzke N, Schafer I. Prevalence of skin lesions and need for treatment in a cohort of 90 880 workers. Br J Dermatol. 2011 Oct;165(4):865-73. doi: 10.1111/j.1365-2133.2011.10436.x.

Reference Type BACKGROUND
PMID: 21623753 (View on PubMed)

Schafer I, Rustenbach SJ, Radtke M, Augustin J, Glaeske G, Augustin M. [Epidemiology of psoriasis in Germany--analysis of secondary health insurance data]. Gesundheitswesen. 2011 May;73(5):308-13. doi: 10.1055/s-0030-1252022. Epub 2010 Jun 11. German.

Reference Type BACKGROUND
PMID: 20544588 (View on PubMed)

de Jong EM, Seegers BA, Gulinck MK, Boezeman JB, van de Kerkhof PC. Psoriasis of the nails associated with disability in a large number of patients: results of a recent interview with 1,728 patients. Dermatology. 1996;193(4):300-3. doi: 10.1159/000246274.

Reference Type BACKGROUND
PMID: 8993953 (View on PubMed)

Klaassen KM, van de Kerkhof PC, Pasch MC. Nail psoriasis: a questionnaire-based survey. Br J Dermatol. 2013 Aug;169(2):314-9. doi: 10.1111/bjd.12354.

Reference Type BACKGROUND
PMID: 23550612 (View on PubMed)

van der Velden HM, Klaassen KM, van de Kerkhof PC, Pasch MC. Fingernail psoriasis reconsidered: a case-control study. J Am Acad Dermatol. 2013 Aug;69(2):245-52. doi: 10.1016/j.jaad.2013.02.009. Epub 2013 Mar 28.

Reference Type BACKGROUND
PMID: 23541759 (View on PubMed)

de Vries AC, Bogaards NA, Hooft L, Velema M, Pasch M, Lebwohl M, Spuls PI. Interventions for nail psoriasis. Cochrane Database Syst Rev. 2013 Jan 31;2013(1):CD007633. doi: 10.1002/14651858.CD007633.pub2.

Reference Type BACKGROUND
PMID: 23440816 (View on PubMed)

Marx JL, Scher RK. Response of psoriatic nails to oral photochemotherapy. Arch Dermatol. 1980 Sep;116(9):1023-24.

Reference Type BACKGROUND
PMID: 7416754 (View on PubMed)

[Narrow spectrum (311 nm) phototherapy in treatment of psoriatic nail]. Georgian Med News. 2009 Feb;(167):56-9. Russian.

Reference Type BACKGROUND
PMID: 19276472 (View on PubMed)

Aubin F, Vigan M, Puzenat E, Blanc D, Drobacheff C, Deprez P, Humbert P, Laurent R. Evaluation of a novel 308-nm monochromatic excimer light delivery system in dermatology: a pilot study in different chronic localized dermatoses. Br J Dermatol. 2005 Jan;152(1):99-103. doi: 10.1111/j.1365-2133.2005.06320.x.

Reference Type BACKGROUND
PMID: 15656808 (View on PubMed)

Mudigonda T, Dabade TS, Feldman SR. A review of protocols for 308 nm excimer laser phototherapy in psoriasis. J Drugs Dermatol. 2012 Jan;11(1):92-7.

Reference Type BACKGROUND
PMID: 22206083 (View on PubMed)

Mudigonda T, Dabade TS, West CE, Feldman SR. Therapeutic modalities for localized psoriasis: 308-nm UVB excimer laser versus nontargeted phototherapy. Cutis. 2012 Sep;90(3):149-54.

Reference Type BACKGROUND
PMID: 23094316 (View on PubMed)

Al-Mutairi N, Al-Haddad A. Targeted phototherapy using 308 nm Xecl monochromatic excimer laser for psoriasis at difficult to treat sites. Lasers Med Sci. 2013 Jul;28(4):1119-24. doi: 10.1007/s10103-012-1210-4. Epub 2012 Sep 28.

Reference Type BACKGROUND
PMID: 23053247 (View on PubMed)

Asawanonda P, Anderson RR, Chang Y, Taylor CR. 308-nm excimer laser for the treatment of psoriasis: a dose-response study. Arch Dermatol. 2000 May;136(5):619-24. doi: 10.1001/archderm.136.5.619.

Reference Type BACKGROUND
PMID: 10815855 (View on PubMed)

Rich P, Scher RK. Nail Psoriasis Severity Index: a useful tool for evaluation of nail psoriasis. J Am Acad Dermatol. 2003 Aug;49(2):206-12. doi: 10.1067/s0190-9622(03)00910-1.

Reference Type BACKGROUND
PMID: 12894066 (View on PubMed)

Aktan S, Ilknur T, Akin C, Ozkan S. Interobserver reliability of the Nail Psoriasis Severity Index. Clin Exp Dermatol. 2007 Mar;32(2):141-4. doi: 10.1111/j.1365-2230.2006.02305.x. Epub 2006 Nov 27.

Reference Type BACKGROUND
PMID: 17137477 (View on PubMed)

Cassell SE, Bieber JD, Rich P, Tutuncu ZN, Lee SJ, Kalunian KC, Wu CW, Kavanaugh A. The modified Nail Psoriasis Severity Index: validation of an instrument to assess psoriatic nail involvement in patients with psoriatic arthritis. J Rheumatol. 2007 Jan;34(1):123-9.

Reference Type BACKGROUND
PMID: 17216680 (View on PubMed)

Yaemsiri S, Hou N, Slining MM, He K. Growth rate of human fingernails and toenails in healthy American young adults. J Eur Acad Dermatol Venereol. 2010 Apr;24(4):420-3. doi: 10.1111/j.1468-3083.2009.03426.x. Epub 2009 Sep 8.

Reference Type BACKGROUND
PMID: 19744178 (View on PubMed)

Ortonne JP, Paul C, Berardesca E, Marino V, Gallo G, Brault Y, Germain JM. A 24-week randomized clinical trial investigating the efficacy and safety of two doses of etanercept in nail psoriasis. Br J Dermatol. 2013 May;168(5):1080-7. doi: 10.1111/bjd.12060.

Reference Type BACKGROUND
PMID: 23013207 (View on PubMed)

de Jong EM, Menke HE, van Praag MC, van De Kerkhof PC. Dystrophic psoriatic fingernails treated with 1% 5-fluorouracil in a nail penetration-enhancing vehicle: a double-blind study. Dermatology. 1999;199(4):313-8. doi: 10.1159/000018281.

Reference Type BACKGROUND
PMID: 10640840 (View on PubMed)

Other Identifiers

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10032937

Identifier Type: OTHER

Identifier Source: secondary_id

FP00004323

Identifier Type: -

Identifier Source: org_study_id

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