Laser treatment for Psoriasis

What is Excimer Laser and how does it work?  Excimer Laser is a special type of laser that uses NBUVB light to treat a variety of skin conditions particularly psoriasis and vitiligo.  There are multiple manufacturers of excimer lasers.  We have been doing these procedures in the office since 2011.  We initially had the name brand XTRAC, but in 2014 switched to what we consider to be a superior excimer laser by Ra Medical called Pharos .

What is the procedure like?  Excimer laser is a painless in-office procedure that is relatively quick and simple compared to other psoriasis treatments.  In our office, the procedure is performed by our medical assistant under the supervision of Dr. Rosenberger.  It takes about 10 minutes depending on the size of the area we are treating.  The first exposure to the laser is usually quite short, lasting as little as a few seconds. Exposure time depends on the person’s skin type and the thickness of the skin.  People with lighter skin start with shorter exposure times than people with darker skin.

Normally, treatment times are gradually increased until clearing occurs, unless the last session produced itching and/or skin tenderness. Because administering excimer laser light is not an exact science, each person’s reaction to the light is not completely predictable. Subsequent sessions of excimer laser are adjusted according to a person’s individual response.

How many treatments does it take? That can vary, depending on the disorder being treated, size of the area being treated, location on the body and the thickness of the psoriasis plaques.  On average patients will see an excellent result within 10 weeks at twice a week.  Many of our patients will do some sort of maintenance therapy at the first appearance of a new flare because they are happy with the therapy.  In the past year we have been using a new protocol that is producing much quicker clearance with improvement often seen in as little as 2-3 weeks.

It is so hard to get an appointment though!  No worries.  For excimer laser treatments, you will be on a separate medical assistant schedule to assure you super prompt service, with no wait to see Dr. Rosenberger.

How does it work?  Present in natural sunlight, ultraviolet light B (UVB) is an effective treatment for psoriasis.  UVB treatment involves exposing the skin to an artificial UVB light source for a set length of time on a regular schedule. As we learn more about these diseases, the theories on how UVB is effective constantly changes and is clearer.  For now, we know it works.  In treatment resistant conditions, just knowing it works is often good enough.

There are two types of UVB treatment, broad band and narrow band. Broad-band UVB is an older method that has been more commonly used in the United States; however, narrow-band UVB is similar in many ways and is becoming more widely used. The major difference between broad-band and narrow-band UVB is that narrow-band UVB units emit a more specific range of UV wavelengths. UVB includes all wavelengths of light between 290-320nm.  Narrow band UVB (NBUVB) includes only wavelengths between 311-313nm.  NBUVB is available both in a booth and in the Excimer laser.  WE HAVE BOTH IN THE OFFICE.

Who is a candidate for Excimer laser?  Excimer laser treatment can be used by adults and children, and will be effective in treating psoriasis for at least two-thirds of patients. We often recommend this treatment to patients who have psoriasis in a limited area (hands, feet, scalp) and to those who have been resistant to treatment with topical therapy.

Excimer laser may be used alone or in combination with other topical and systemic treatments. More recently, we have been treating patients with both Otezla and NBUVB and seeing some remarkable responses.

Excimer laser requires a significant time commitment. People get the best results when they keep scheduled appointments and follow treatment directions carefully.

What happens once the skin clears? Once the skin clears, the treatments can be stopped. They should be resumed if the lesions begin to reappear. Sometimes Excimer laser can be continued on a maintenance basis. Studies show that any treatment with NBUVB as maintenance can increase remission time..

What are the side effects of Excimer laser treatment?  During treatment, psoriasis may worsen temporarily before improving, but this is VERY rare.  The skin may itch and become red because of exposure to the UVB light. The amount of UVB administered may need to be reduced to avoid further irritation.  In our initial years, we would often see some patients develop blistering after treatment.  The Pharos laser is a superior device and blistering is very uncommon now. UVB is an established carcinogen (cancer-causing substance or agent) in humans. However, there is no direct evidence of increased risk of skin cancer from UVB treatment for psoriasis. It is important to have a doctor examine your skin periodically. Skin cancers generally can be removed easily if detected early.

Insurance Coverage and Prior Authorization  We may ask you to contact your insurance company regarding insurance coverage and prior authorization.  The Codes you will need are CPT 96920, 96921 and 96922 depending on the size of area treated. Generally it is well covered by most insurances including Medicare for psoriasis. It is less often covered for vitiligo.

To learn more about this and other treatment options for psoriasis, I would recommend visiting the National Psoriasis Foundation website .