Psoriasis: Can XTRAC laser treatment help?
It is not a first-line treatment for psoriasis, but there is evidence to suggest that it can help reduce or remove skin symptoms.
What is the XTRAC laser?
A doctor may recommend laser therapy for psoriasis.
People with psoriasis have long used light therapy, or phototherapy, to reduce symptoms and improve flares more quickly.
The Excimer laser, of which XTRAC is one brand, works at a wavelength of 308 nanometers and uses the same principles as phototherapy but with faster results. The laser uses a highly concentrated form of ultraviolet (UV) B light to attack the DNA of T cells.
T cells are a type of white blood cell that play a role in immunity. Scientists believe that in psoriasis, there is an immune system problem involving the T cells, resulting in changes to skin growth and the development of plaques.
The laser works through various mechanisms to improve the appearance of the plaques that feature in psoriasis. One of these mechanisms appears to affect the immune system, including the T cells.
The results of a 2016 review suggest that receiving excimer laser treatment twice per week for 12 weeks could improve symptoms in nail, scalp, and palmoplantar psoriasis.
In the following sections, we cover the risks and benefits of XTRAC laser therapy.
Psoriasis is a chronic inflammatory condition involving a dysregulation in the immune system that features skin changes and other symptoms. There is no cure, but treatment can help a person manage and improve their symptoms.
The XTRAC laser can improve symptoms, but it cannot treat the underlying condition that causes them.
For this reason, a person will need to continue treatment as long as there is skin involvement. Psoriasis involves flares (periods of worsening symptoms) and remission (periods when they subside).
XTRAC can help improve skin-related symptoms, but they may return when another flare occurs. That said, XTRAC excimer treatment can help reduce the length of a flare.
Which types of psoriasis can it treat?
In studies, people with scalp psoriasis have benefited from XTRAC laser treatment.
XTRAC can treat several forms of psoriasis but is most useful when it affects only small areas of the body.
Data on proper dosage are limited. It may depend on the type of psoriasis a person has, how severe the symptoms are, skin type, and the thickness of any lesions.
Research into the effectiveness of excimer lasers has mostly been supportive. For example, one 2016 review found that when 13 people with scalp psoriasis received excimer laser treatment on one side of their head twice per week for 15 weeks, symptoms improved significantly.
When 42 people with nail psoriasis had excimer laser treatment twice per week for 12 weeks, 38% saw an improvement of 50% or more.
In research involving people with palmoplantar pustular psoriasis, which can make it hard to use the hands and feet, 64% of participants who underwent excimer laser therapy experienced an improvement of 70% or more.
People can also use XTRAC laser therapy alongside other treatments, such as clobetasol propionate spray and calcipotriene ointment, which are topical treatments.
In a study involving 30 people, 83% saw significant improvements after having laser treatment twice per week and alternating topical treatment with clobetasol and calcipotriene twice per day for 12 weeks. The two treatments appeared to work together to provide extra benefit.
Psoriasis can trigger bothersome skin changes that can cause feelings of self-consciousness. Finding an effective treatment can help improve both physical well-being and quality of life for a person with psoriasis.
The XTRAC laser acts directly on the most visible symptoms of psoriasis, often significantly reducing the severity and length of a flare.
Other benefits include:
Rapid, visible results: Excimer lasers can improve the appearance of psoriasis plaques quickly and effectively.
An alternative treatment: Some people prefer not to use other psoriasis medications or find that they cannot tolerate the side effects. Others may have stubborn areas that may not be improving with topical therapy and instead may respond to the addition of an excimer laser.
Relatively well tolerated: The side effects of excimer lasers tend to be minimal, and treatment is not usually painful.
No recovery needed: Excimer lasers can target specific areas, which helps prevent damage to skin that psoriasis does not affect.
Low UV exposure: Traditional phototherapy involves exposing large areas of skin to UV light. Excimer laser therapy can target a precise area, reducing the risk to other parts of the body.
There are a few risks associated with this kind of treatment:
A person needs to repeat the treatment for it to be effective, and this can take time. Stubborn or extensive lesions can take longer to improve.
Some insurance plans may cover excimer laser treatment, but requirements vary. A person may have to try other treatments first, and they must often meet a deductible or pay a copayment. The cost will depend largely on a person's insurance plan.
Treatment with excimer lasers is fairly painless, but some people experience burning or a hot sensation during the procedure.
Side effects tend to be minimal, especially compared with medications such as steroids and biologics. However, they may include:
- redness (in light skin) or purpleness (in dark skin)
- temporary pain
- pigmentation changes
If blisters form, a person should leave them to dry out and not pop them. The treated skin can become infected, but this is uncommon.
A person will normally continue to use their regular medication alongside laser treatment, but they should speak to their doctor before having the treatment.
Other phototherapy options
Light therapy is a standard treatment option for psoriasis.
The XTRAC laser is not 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, according to one 2014 study.
PDL treatment uses a device filled with pigment molecules. Light from the device causes these molecules to emit radiation. PDL treatment targets specific substances, which selectively absorb energy from the laser. This produces heat, which destroys diseased tissue.
This treatment is usually safe, but skin injuries can occur if healthy skin absorbs radiation. Side effects include bruising, infection, and other skin injuries.
Other light therapies that may help include:
- long-term, UV-free blue light treatment
- visible light phototherapy alongside oral extract of Curcuma longa
A person should talk to their doctor before taking any herbal supplements and only seek light treatment from a qualified professional.
People with psoriasis should weigh these risks against potential benefits while comparing the potential effectiveness of different treatment options.
Other psoriasis treatments
There is no cure for psoriasis, but appropriate treatment can often result in long periods of remission.
Combining two or more therapies may offer additional relief. Other treatments to try include:
Biologic drugs: Biologics appear to work by targeting the dysregulation in the immune system that occurs in psoriasis. They help reduce flares and improve symptoms, but they may have adverse effects. A person will usually take them as an injection or infusion, usually in the doctor's office but sometimes at home.
Systemic drugs: Cyclosporine, methotrexate, and oral retinoids are some examples. These can improve symptoms, but they may also have adverse effects.
Topical remedies: Treatments that a person can apply directly to the skin include corticosteroids and synthetic vitamin D.
A person may also wish to try some prevention methods and home remedies, such:
Avoiding known triggers: Where possible, it may help to avoid stress, smoking, alcohol, and certain foods. It may also be worth avoiding certain medications and working to lower the risk of infections.
Trying complementary and alternative remedies: The National Center for Complementary and Integrative Health suggest that dietary supplements and herbal medicines, such as fish oil and Mahonia aquifolium, may help.
However, more evidence is necessary to confirm their effectiveness and long-term benefits. An individual should ask their doctor or dermatologist before starting to take any herbal supplements.
Some people with psoriasis follow special diets, but there is no evidence to suggest that one diet is better than another for psoriasis.
Light therapy, including treatment with an XTRAC excimer laser, may help reduce the symptoms of psoriasis.
However, a person should speak to their doctor to check that this treatment is appropriate.
If I go for laser treatment, how long will it take, and what shall I wear? Can I do it in my lunch break?
The length of treatment depends on the area of the body that needs it. The procedure itself is relatively short, sometimes only a few minutes, especially if it involves only a small area of the body.
It is best to check with the dermatology office performing the laser treatment first to understand their protocol.
Plan on wearing clothing that will protect the treated area of skin from excessive sun exposure when leaving the office.
Before the appointment, do not apply anything to the skin areas that the procedure will be targeting.
It may be possible to receive the treatment during a lunch break, but an appointment can involve time-consuming factors aside from the actual treatment, so ask the office in advance and plan accordingly.Owen Kramer, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.