CO2 laser resurfacing of psoriatic plaques:: A pilot study

Background and Objective: Laser resurfacing can precisely remove epidermis and papillary dermis, sites pivotal to the pathogenesis of psoriasis. Our objective was to determine the efficacy and safety of superficially ablating carbon dioxide (CO2) lasers for treating isolated, recalcitrant psoriatic plaques. Materials and Methods: Twelve adult subjects with stable, plaque-type psoriasis were recruited. In six volunteers, the quadrants received different numbers of passes with a 60 mu sec pulsed CO2 (Tru-Pulse) laser. In the remaining patients, one quadrant underwent curettage prior to resurfacing, the second resurfacing with a scanned continuous wave (Sharplan Silk-touch) CO2 laser and the last curettage alone. Results: Despite clinical and histological evidence of complete ablation of the epidermis and papillary dermis, most quadrants recurred within 8 weeks. Surprisingly, two patients showed no recurrence after 4 months. Conclusion: Ablation of the entire epidermis and papillary dermis with either pulsed or scanned CO2 lasers appears generally ineffective in treating recalcitrant psoriatic plaques, although the clearing seen in two patients suggests potentially successful future research directions. (C) 1998 Wiley-Liss, Inc.