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Abstract：
Nail psoriasis is a chronic, inflammatory condition which is difficult to treat, linked with greater psoriasis severity, and may be associated with anxiety and significant functional impairment of the quality of life. The 1064 nm Nd: YAG laser was reported to yield satisfactory results in the treatment of nail psoriasis.The aim of the study was to assess the clinical and ultrasonographic efficacy of long-pulsed 1064 nm Nd: YAG laser in the treatment of fingernail psoriasis and compare its effect to control fingernails.This intra-patient randomized controlled trial analyzed 86 fingernails collected from 13 patients suffering from cutaneous and nail psoriasis. The nails were randomized into two groups. Group A was treated with Nd: YAG laser once monthly for three sessions while group B served as control. Assessment took place at baseline, 1 and 3 months after the last treatment session. For scoring, the 32-points target NAPSI scoring systems was used. Additionally, two blinded dermatologists\' score of improvement, patients\' pain assessment by visual analogue score and ultrasonographic assessment were all performed.At the end of follow up, the medians of tNAPSI score, plate definition, matrix thickness, bed thickness and bed vascularity decreased significantly in the Nd: YAG laser treated group in comparison to baseline (p = 0.001, 0.006, 0.039, < 0.001 and 0.010, respectively). While, there was a non-significant reduction in median tNAPSI score in the control group at last follow up, however, ultrasonography recorded a significant reduction in the medians of plate definition, bed thickness and vascularity (p = 0.002, 0.011 and 0.033, respectively) from the baseline. Comparison of the Nd: YAG laser and the control groups showed no significant difference from baseline regarding the medians of tNAPSI, tNAPSI percentile improvement, pits count, blinded evaluation of photographs and ultrasonographic assessments.In conclusion, Nd: YAG laser showed clinical and ultrasonographic improvement in fingernail psoriasis. Ultrasonography is a useful noninvasive tool in diagnosing and monitoring the clinical and even the subclinical changes in nail psoriasis. Nail psoriasis although difficult to treat, may show spontaneous improvement.
摘要：
指甲牛皮癣是一种慢性，难以治疗的炎症，与更严重的牛皮癣有关，并可能与焦虑和显著的生活质量功能损害有关。据报道，1064nmNd：YAG激光在治疗指甲牛皮癣方面取得了令人满意的效果。该研究的目的是评估长脉冲1064nmNd：YAG激光治疗指甲牛皮癣的临床和超声疗效，并比较其与控制指甲的效果。这项患者内部随机对照试验分析了从13名患有皮肤和指甲牛皮癣的患者中收集的86个指甲。将指甲随机分为两组。A组采用Nd：YAG激光治疗，每月一次，共三个疗程，而B组作为对照组。评估是在基线进行的，最后一次治疗后1和3个月。为了得分，使用32分目标NAPSI评分系统.此外,两名失明的皮肤科医生评分改善，所有患者均通过视觉模拟评分和超声检查进行疼痛评估.在后续行动结束时，tNAPSI得分的中位数，板定义,基体厚度,与基线相比,Nd:YAG激光治疗组的床层厚度和床层血管分布显著下降(分别为p=0.001,0.006,0.039,<0.001和0.010).同时,对照组末次随访时tNAPSI评分中位数无显著降低,然而,超声记录板定义的中位数显着降低，从基线开始，床层厚度和血管分布（分别为p=0.002、0.011和0.033）。Nd：YAG激光和对照组的比较显示tNAPSI的中位数与基线没有显着差异，tNAPSI百分位数改进，凹坑计数,照片和超声评估的盲法评估。总之,Nd：YAG激光显示指甲银屑病的临床和超声改善。超声检查是诊断和监测指甲牛皮癣临床甚至亚临床变化的有用非侵入性工具。指甲牛皮癣虽然难以治疗，可能表现出自发的改善。
