Ablative techniques in Psoriasis vulgaris resistant to conventional therapies.

BACKGROUND

Treatment of patients with psoriasis vulgaris exhibiting only solitary plaque-stage lesions might become difficult since topical treatments often fail and systemic therapies seem inappropriate.

OBJECTIVE

We evaluated the feasibility of ablative techniques in this clinical setting comparing dermatome shaving to the application of an Er:YAG laser.

METHODS

Six patients were treated by means of dermatome shaving; in four of these patients additional lesions were ablated utilizing an Er:YAG laser (2 J, 10 Hz, 5 mm spot size).

RESULTS

Four of six patients experienced complete clearance of the lesions treated, three of the four patients receiving additional Er:YAG treatment also showed a complete clinical response.

CONCLUSION

Our observations document that removal of epidermis and the papillary dermis is effective in treating recalcitrant psoriatic plaques. The Er:YAG laser represents a state-of-the-art device for performing this task. The beneficial effect on skin might be due to clearance of the putative autoantigen along with a considerable part of the potential effector cell population.