Use of Lasers for the Treatment of Psoriasis and Vitiligo

  • Maya G. DebbanehEmail author
  • Eric S. Lee
  • John Koo
  • Judith Hong


Psoriasis and vitiligo are two chronic inflammatory skin conditions that have long been treated with phototherapy. Recently, laser theropy has become an alternative to generalized light treatment, as lesions can be targeted more directly and generally require less treatment sessions. While a variety of lasers have been tested for both the treatment of psoriasis and vitiligo, the most commonly used laser for this purpose is the excimer laser, which uses a wavelength of 308 nm. This chapter discusses the indications and use of lasers in the treatment of psoriasis and vitiligo.


Laser Psoriasis Vitiligo Hypopigmentation Phototherapy Excimer 


  1. 1.
    Gattu S, Pagushetti R, Koo J. Moderate to severe psoriasis. 3rd ed. Boca Raton: CRC Press; 2009. p. 75–113.Google Scholar
  2. 2.
    Gattu S, Pang ML, Pugashetti R, Malick F, Hong J, Bowers E, et al. Pilot evaluation of supra-erythemogenic phototherapy with excimer laser in the treatment of patients with moderate to severe plaque psoriasis. J Dermatolog Treat. 2010;21(1):54–60. Epub 2009/08/28.PubMedCrossRefGoogle Scholar
  3. 3.
    Hong J, Malick F, Sivanesan P, Koo J. Expanding the use of the 308 nm excimer laser for treatment of psoriasis. Pract Dermatol. 2007;S13–6.Google Scholar
  4. 4.
    Alhowaish AK, Dietrich N, Onder M, Fritz K. Effectiveness of a 308-nm excimer laser in treatment of vitiligo: a review. Lasers Med Sci. 2013;28:1035–41.PubMedCrossRefGoogle Scholar
  5. 5.
    Enamandram M, Kimball AB. Psoriasis epidemiology: the interplay of genes and the environment. J Invest Dermatol. 2013;133(2):287–9. Epub 2013/01/16.PubMedCrossRefGoogle Scholar
  6. 6.
    Armstrong AW, Schupp C, Wu J, Bebo B. Quality of life and work productivity impairment among psoriasis patients: findings from the National Psoriasis Foundation survey data 2003–2011. PLoS One. 2012;7(12):e52935. Epub 2013/01/04.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Rapp SR, Feldman SR, Exum ML, Fleischer Jr AB, Reboussin DM. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol. 1999;41(3 Pt 1):401–7. Epub 1999/08/25.PubMedCrossRefGoogle Scholar
  8. 8.
    Carrascosa JM, Tapia G, Bielsa I, Fuente MJ, Ferrandiz C. Effects of narrowband UV-B on pharmacodynamic markers of response to therapy: an immunohistochemical study over sequential samples. J Cutan Pathol. 2007;34(10):769–76. Epub 2007/09/21.PubMedCrossRefGoogle Scholar
  9. 9.
    Goettsch W, Hurks HM, Garssen J, Mommaas AM, Slob W, Hoekman J, et al. Comparative immunotoxicology of ultraviolet B exposure I. Effects of in vitro and in situ ultraviolet B exposure on the functional activity and morphology of Langerhans cells in the skin of different species. Br J Dermatol. 1998;139(2):230–8. Epub 1998/10/10.PubMedCrossRefGoogle Scholar
  10. 10.
    He YL, Zhang XY, Dong J, Xu JZ, Wang J. Clinical efficacy of a 308 nm excimer laser for treatment of psoriasis vulgaris. Photodermatol Photoimmunol Photomed. 2007;23(6):238–41. Epub 2007/11/08.PubMedCrossRefGoogle Scholar
  11. 11.
    Taibjee SM, Cheung ST, Laube S, Lanigan SW. Controlled study of excimer and pulsed dye lasers in the treatment of psoriasis. Br J Dermatol. 2005;153(5):960–6. Epub 2005/10/18.PubMedCrossRefGoogle Scholar
  12. 12.
    Feldman SR, Mellen BG, Housman TS, Fitzpatrick RE, Geronemus RG, Friedman PM, et al. Efficacy of the 308-nm excimer laser for treatment of psoriasis: results of a multicenter study. J Am Acad Dermatol. 2002;46(6):900–6. Epub 2002/06/14.PubMedCrossRefGoogle Scholar
  13. 13.
    Trehan M, Taylor CR. Medium-dose 308-nm excimer laser for the treatment of psoriasis. J Am Acad Dermatol. 2002;47(5):701–8. Epub 2002/10/26.PubMedCrossRefGoogle Scholar
  14. 14.
    Fikrle T, Pizinger K. The use of the 308 nm excimer laser for the treatment of psoriasis. J Dtsch Dermatol Ges. 2003;1(7):559–63. Epub 2005/11/22. Die Anwendung des Excimerlasers 308 nm zur Psoriasis-Behandlung.PubMedCrossRefGoogle Scholar
  15. 15.
    Dong J, He Y, Zhang X, Wang Y, Tian Y, Wang J. Clinical efficacy of flumetasone/salicylic acid ointment combined with 308-nm excimer laser for treatment of psoriasis vulgaris. Photodermatol Photoimmunol Photomed. 2012;28(3):133–6. Epub 2012/05/03.PubMedCrossRefGoogle Scholar
  16. 16.
    Wong JW, Nguyen TV, Bhutani T, Koo JY. Treatment of psoriasis and long-term maintenance using 308 nm excimer laser, clobetasol spray, and calcitriol ointment: a case series. J Drugs Dermatol. 2012;11(8):994–6. Epub 2012/08/04.PubMedGoogle Scholar
  17. 17.
    Casacci M, Thomas P, Pacifico A, Bonnevalle A, Paro Vidolin A, Leone G. Comparison between 308-nm monochromatic excimer light and narrowband UVB phototherapy (311–313 nm) in the treatment of vitiligo–a multicentre controlled study. J Eur Acad Dermatol Venereol. 2007;21(7):956–63. Epub 2007/07/31.PubMedCrossRefGoogle Scholar
  18. 18.
    Teovska Mitrevska N, Eleftheriadou V, Guarneri F. Quality of life in vitiligo patients. Dermatol Ther. 2012;25 Suppl 1:S28–31. Epub 2012/12/19.PubMedCrossRefGoogle Scholar
  19. 19.
    Fitzpatrick TB. Mechanisms of phototherapy of vitiligo. Arch Dermatol. 1997;133(12):1591–2. Epub 1998/01/08.PubMedCrossRefGoogle Scholar
  20. 20.
    Morelli JG, Kincannon J, Yohn JJ, Zekman T, Weston WL, Norris DA. Leukotriene C4 and TGF-alpha are stimulators of human melanocyte migration in vitro. J Invest Dermatol. 1992;98(3):290–5. Epub 1992/03/01.PubMedCrossRefGoogle Scholar
  21. 21.
    Duthie MS, Kimber I, Norval M. The effects of ultraviolet radiation on the human immune system. Br J Dermatol. 1999;140(6):995–1009. Epub 1999/06/03.PubMedCrossRefGoogle Scholar
  22. 22.
    Kwok YK, Anstey AV, Hawk JL. Psoralen photochemotherapy (PUVA) is only moderately effective in widespread vitiligo: a 10-year retrospective study. Clin Exp Dermatol. 2002;27(2):104–10. Epub 2002/04/16.PubMedCrossRefGoogle Scholar
  23. 23.
    Westerhof W, Nieuweboer-Krobotova L. Treatment of vitiligo with UV-B radiation vs topical psoralen plus UV-A. Arch Dermatol. 1997;133(12):1525–8. Epub 1998/01/08.PubMedCrossRefGoogle Scholar
  24. 24.
    Berneburg M, Rocken M, Benedix F. Phototherapy with narrowband vs broadband UVB. Acta Derm Venereol. 2005;85(2):98–108. Epub 2005/04/13.PubMedCrossRefGoogle Scholar
  25. 25.
    Ibbotson SH, Bilsland D, Cox NH, Dawe RS, Diffey B, Edwards C, et al. An update and guidance on narrowband ultraviolet B phototherapy: a British Photodermatology Group Workshop Report. Br J Dermatol. 2004;151(2):283–97. Epub 2004/08/26.PubMedCrossRefGoogle Scholar
  26. 26.
    Njoo MD, Bos JD, Westerhof W. Treatment of generalized vitiligo in children with narrow-band (TL-01) UVB radiation therapy. J Am Acad Dermatol. 2000;42(2 Pt 1):245–53. Epub 2000/01/22.PubMedCrossRefGoogle Scholar
  27. 27.
    Ostovari N, Passeron T, Zakaria W, Fontas E, Larouy JC, Blot JF, et al. Treatment of vitiligo by 308-nm excimer laser: an evaluation of variables affecting treatment response. Lasers Surg Med. 2004;35(2):152–6. Epub 2004/08/31.PubMedCrossRefGoogle Scholar
  28. 28.
    Hadi SM, Spencer JM, Lebwohl M. The use of the 308-nm excimer laser for the treatment of vitiligo. Dermatol Surg. 2004;30(7):983–6. Epub 2004/06/24.PubMedGoogle Scholar
  29. 29.
    Morison WL, Atkinson DF, Werthman L. Effective treatment of scalp psoriasis using the excimer (308 nm) laser. Photodermatol Photoimmunol Photomed. 2006;22(4):181–3. Epub 2006/07/28.PubMedCrossRefGoogle Scholar
  30. 30.
    Taylor CR, Racette AL. A 308-nm excimer laser for the treatment of scalp psoriasis. Lasers Surg Med. 2004;34(2):136–40. Epub 2004/03/09.PubMedCrossRefGoogle Scholar
  31. 31.
    Wong JW, Kamangar F, Nguyen TV, Koo JY. Excimer laser therapy for hairline psoriasis: a useful addition to the scalp psoriasis treatment algorithm. Skin Therapy Lett. 2012;17(5):6–9. Epub 2012/05/25.PubMedGoogle Scholar
  32. 32.
    Al-Mutairi N, Al-Haddad A. Targeted phototherapy using 308 nm Xecl monochromatic excimer laser for psoriasis at difficult to treat sites. Lasers Med Sci. 2013;28:1119–24.PubMedCrossRefGoogle Scholar
  33. 33.
    Goldberg DJ, Chwalek J, Hussain M. 308-nm Excimer laser treatment of palmoplantar psoriasis. J Cosmet Laser Ther. 2011;13(2):47–9. Epub 2011/03/16.PubMedCrossRefGoogle Scholar
  34. 34.
    Neumann NJ, Mahnke N, Korpusik D, Stege H, Ruzicka T. Treatment of palmoplantar psoriasis with monochromatic excimer light (308-nm) versus cream PUVA. Acta Derm Venereol. 2006;86(1):22–4. Epub 2006/04/06.PubMedGoogle Scholar
  35. 35.
    Nistico SP, Saraceno R, Stefanescu S, Chimenti S. A 308-nm monochromatic excimer light in the treatment of palmoplantar psoriasis. J Eur Acad Dermatol Venereol. 2006;20(5):523–6. Epub 2006/05/11.PubMedCrossRefGoogle Scholar
  36. 36.
    Aubin F, Vigan M, Puzenat E, Blanc D, Drobacheff C, Deprez P, et al. Evaluation of a novel 308-nm monochromatic excimer light delivery system in dermatology: a pilot study in different chronic localized dermatoses. Br J Dermatol. 2005;152(1):99–103. Epub 2005/01/20.PubMedCrossRefGoogle Scholar
  37. 37.
    Oram Y, Karincaoglu Y, Koyuncu E, Kaharaman F. Pulsed dye laser in the treatment of nail psoriasis. Dermatol Surg. 2010;36(3):377–81. Epub 2010/01/27.PubMedCrossRefGoogle Scholar
  38. 38.
    Treewittayapoom C, Singvahanont P, Chanprapaph K, Haneke E. The effect of different pulse durations in the treatment of nail psoriasis with 595-nm pulsed dye laser: a randomized, double-blind, intrapatient left-to-right study. J Am Acad Dermatol. 2012;66(5):807–12. Epub 2012/01/17.PubMedCrossRefGoogle Scholar
  39. 39.
    Pahlajani N, Katz BJ, Lozano AM, Murphy F, Gottlieb A. Comparison of the efficacy and safety of the 308 nm excimer laser for the treatment of localized psoriasis in adults and in children: a pilot study. Pediatr Dermatol. 2005;22(2):161–5. Epub 2005/04/05.PubMedCrossRefGoogle Scholar
  40. 40.
    Tauscher AE, Fleischer Jr AB, Phelps KC, Feldman SR. Psoriasis and pregnancy. J Cutan Med Surg. 2002;6(6):561–70. Epub 2002/10/04.PubMedCrossRefGoogle Scholar
  41. 41.
    Cho S, Zheng Z, Park YK, Roh MR. The 308-nm excimer laser: a promising device for the treatment of childhood vitiligo. Photodermatol Photoimmunol Photomed. 2011;27(1):24–9. Epub 2011/01/05.PubMedCrossRefGoogle Scholar
  42. 42.
    Yang YS, Cho HR, Ryou JH, Lee MH. Clinical study of repigmentation patterns with either narrow-band ultraviolet B (NBUVB) or 308 nm excimer laser treatment in Korean vitiligo patients. Int J Dermatol. 2010;49(3):317–23. Epub 2010/05/15.PubMedCrossRefGoogle Scholar
  43. 43.
    XTRAC PhotoMedex Excimer Laser Clinical Reference Guide.Google Scholar
  44. 44.
    Lee E, Koo J, Berger T. UVB phototherapy and skin cancer risk: a review of the literature. Int J Dermatol. 2005;44(5):355–60. Epub 2005/05/05.PubMedCrossRefGoogle Scholar
  45. 45.
    Lebwohl M, Martinez J, Weber P, DeLuca R. Effects of topical preparations on the erythemogenicity of UVB: implications for psoriasis phototherapy. J Am Acad Dermatol. 1995;32(3):469–71. Epub 1995/03/01.PubMedCrossRefGoogle Scholar
  46. 46.
    Taneja A, Trehan M, Taylor CR. 308-nm excimer laser for the treatment of psoriasis: induration-based dosimetry. Arch Dermatol. 2003;139(6):759–64. Epub 2003/06/18.PubMedCrossRefGoogle Scholar
  47. 47.
    Housman TS, Pearce DJ, Feldman SR. A maintenance protocol for psoriasis plaques cleared by the 308 nm excimer laser. J Dermatolog Treat. 2004;15(2):94–7. Epub 2004/06/19.PubMedCrossRefGoogle Scholar
  48. 48.
    Trehan M, Taylor CR. High-dose 308-nm excimer laser for the treatment of psoriasis. J Am Acad Dermatol. 2002;46(5):732–7. Epub 2002/05/11.PubMedCrossRefGoogle Scholar
  49. 49.
    Kagen M, Cao LY, Oyetakin-White P, Tacastacas JD, Yan C, McCormick TS, et al. Single administration of lesion-limited high-dose (TURBO) ultraviolet B using the excimer laser: clinical clearing in association with apoptosis of epidermal and dermal T cell subsets in psoriasis. Photodermatol Photoimmunol Photomed. 2012;28(6):293–8. Epub 2012/11/07.PubMedCrossRefGoogle Scholar
  50. 50.
    Zerbinati N, Portale S, Palmieri B, Rottigni V, Iannitti T. A preliminary study to assess the efficacy of a new UVA1 laser for treatment of psoriasis. Photomed Laser Surg. 2012;30(10):610–4. Epub 2012/08/15.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Maya G. Debbaneh
    • 1
    Email author
  • Eric S. Lee
    • 2
  • John Koo
    • 3
  • Judith Hong
    • 4
  1. 1.Department of DermatologyUniversity of California, IrvineSan FranciscoUSA
  2. 2.Department of Dermatology and Cutaneous SurgeryUniversity of Miami—Miller School of MedicineMiamiUSA
  3. 3.Department of DermatologyUniversity of California, San Francisco Psoriasis CenterSan FranciscoUSA
  4. 4.Department of DermatologySan Francisco Veteran Affairs Medical CenterSanta RosaUSA

Personalised recommendations