Ablative techniques in psoriasis vulgaris resistant to conventional therapies

BACKGROUND. Treatment of patients with psoriasis vulgaris exhibiting only s olitary plaque-stage lesions might become difficult since topical treatment s often fail and systemic therapies seem inappropriate. OBJECTIVE. We evaluated the feasibility of ablative techniques in this clin ical setting comparing dermatome shaving to the application of an Er:YAG la ser. METHODS. Six patients were treated by means of dermatome shaving; in four o f 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 pap illary 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 au toantigen along with a considerable part of the potential effector cell pop ulation.