Approved by the United States Food and Drug Administration (FDA) in 2000, XTRAC uses ultraviolet light to reduce the appearance of large patches of psoriasis.
What is the XTRAC laser?
People with psoriasis have long used light therapy to reduce symptoms and more quickly clear psoriasis outbreaks. The XTRAC laser uses the same principles as phototherapy, but with more rapid results. Using a highly concentrated form of ultraviolet-B (UVB) light, the laser attacks the DNA of T-cells.
Phototherapy or light therapy may be used to treat psoriasis outbreaks.
T-cells are a type of white blood cell that plays a role in immunity. In psoriasis, the body overproduces T-cells, triggering the development of plaques. By breaking up T-cells, the laser shortens the duration of each outbreak. It can significantly clear large patches of psoriasis in a single treatment session.
Excimer lasers, including XTRAC, work at a wavelength of 308 nanometers.
XTRAC can also treat vitiligo, which destroys skin pigment cells, causing white patches on the skin.
Treatment is normally two to three times per week, but with a minimum of 48 hours between each treatment session.
Understanding treatment with the XTRAC laser
Psoriasis is a chronic autoimmune condition. It can only be controlled, not cured. While the XTRAC laser addresses an underlying cause of psoriasis - T-cell overproduction - it cannot treat the fundamental autoimmune condition that causes this buildup.
Thus treatment will need to continue as long as there are symptoms. Psoriasis attacks will continue even with aggressive XTRAC treatment. Excimer lasers can, however, shorten the length of outbreaks by clearing plaques more quickly than the body can on its own.
Which types of psoriasis does the XTRAC laser treat?
XTRAC can treat all forms of psoriasis, including plaque, guttate, inverse, pustular, and erythrodermic psoriasis.
Data on proper dosage is limited. According to the American Academy of Dermatology Association, dosing is normally based on the person's skin type and the thickness of the psoriasis lesion. Adjustments may be made based on side effects the person may experience and their response to the laser.
Research into the effectiveness of excimer lasers is generally supportive:
- A 2004 case study of scalp psoriasis reported a 90 percent reduction in symptoms after 11 weeks and 23 treatments.
- A 2014 review points to the efficacy of phototherapy. It looked at five excimer laser studies and found the treatment could reduce symptoms of palmoplantar pustular psoriasis.
- A 2015 case study found better results in a person with plaque psoriasis when a more aggressive approach to treatment was used.
- A 2014 comparison study compared excimer lasers with pulsed dye laser for reducing symptoms of nail psoriasis. Although there was some improvement with excimer laser therapy, pulsed dye lasers were more effective at reducing symptoms.
- A 2002 study found that 10 excimer laser treatments produced 75 percent improvement or better in 84 percent of participants.
Pros and cons
Psoriasis is a chronic autoimmune condition that may affect anyone.
Psoriasis is more than just an irritating skin condition. People with psoriasis may feel depressed and self-conscious. If the psoriasis is visible, it can result in discrimination and bullying.
The XTRAC laser acts directly on the most visible symptom of psoriasis, often significantly reducing the severity and length of an outbreak.
Other benefits include:
- Rapid, visible results. Excimer lasers can rapidly break up large psoriasis outbreaks.
- An alternative to other treatments. For some people, psoriasis drugs don't work while others find the side effects intolerable.
- Relatively well tolerated. The side effects of excimer lasers are generally minimal, and treatment is not painful.
- No down time after treatment.
Traditional phototherapy takes longer and is less effective than targeted lasers. Lasers offer targeted treatment, stopping damage and irritation to skin not affected by psoriasis lesions.
Drawbacks and side effects
The main drawback of excimer lasers is the time commitment, as the treatment must be repeated to be effective. Regular treatments can become quite time-consuming for people with severe psoriasis or who have frequent outbreaks.
Treatment with excimer lasers is fairly painless, though some patients experience burning or a hot sensation during treatment.
The side effects of XTRAC and other excimer lasers are generally minimal. They are particularly minimal when compared with medications such as steroids and biologics.
Some of the most common side effects include:
- temporary pain
- skin redness
- itching, flaky, scaly skin
- psoriasis flare-ups
- peeling skin
- oozing psoriasis lesions
It's possible for the treated skin to become infected, but this is uncommon.
Most insurance plans cover excimer laser treatment, but requirements vary. A person may have to try other treatments first, and often must meet a deductible, or pay a copayment. As a result, the cost of treatment largely depends on a person's insurance plan.
Other phototherapy options
The XTRAC laser is far from the only phototherapy-based treatment for psoriasis. For some forms of psoriasis, particularly nail psoriasis, treatment with pulsed dye laser (PDL) may be a better option.
PDL treatment uses a device filled with pigment molecules. Light from the device causes these molecules to emit radiation. Skin cells selectively absorb heat from the laser, killing diseased tissue without affecting healthy tissue.
This treatment is safe generally, but skin injuries can occur if healthy skin absorbs radiation. Side effects include bruising, infection, and other skin injuries.
People with psoriasis should weigh these risks against potential benefits while comparing the potential effectiveness of different treatment options.
A further option, using more traditional phototherapy, involves exposing large portions of skin to ultraviolet light. While traditional phototherapy can be effective, it is typically less effective than PDL or excimer lasers.
Other psoriasis treatments
There is no cure for psoriasis, though people can often achieve long periods of remission with the right treatment plan. Some people blend two or more therapies to achieve greater relief.
Some options include:
Avoiding psoriasis triggers such as allergens and stress may help to alleviate symptoms.
- systemic drugs, such as cyclosporine, that can be taken orally or via injection
- protein-based biologic drugs, which are typically administered via a small injection or a needle in a vein
- "small molecule" oral treatments that target immune cells
- remedies applied to the skin, including corticosteroids
- avoiding psoriasis triggers such as allergens, stress, or certain foods
- complementary and alternative remedies, such as psychotherapy, acupuncture, and herbal remedies
Lifestyle changes may also help. Some people with psoriasis adopt special diets or try other strategies. Research into the effectiveness of these strategies is at an early stage and results are mixed.