Laser treatment of psoriasis

In psoriasis, the earliest observable electron microscopic changes are in the dermal papillary vasculature. The flashlamp-pumped pulsed tunable dye laser can achieve selective photothermolysis of the dermal vasculature. This laser was used to treat eight patients with chronic plaque psoriasis, as it was hypothesized that the ablation of dermal papillary vasculature would arrest the early events leading to the evolution of psoriasis, and produce resolution of the plaques. At the final assessment, performed 10 weeks after three fortnightly laser treatments, five of the eight patients recorded an improvement of > or = 50%, and one showed complete resolution of the treated plaques of psoriasis. Although not practicable in the treatment of widespread psoriasis, we conclude that selective photothermolysis of the dermal vasculature by pulsed tunable dye laser offers an alternative new therapy for chronic plaque psoriasis, and also demonstrates the pivotal role of the vasculature in the pathogenesis of psoriasis.