Excimer Laser Therapy for Psoriasis Treatment

While many treatments for psoriasis focus on topical medications, like creams and lotions, or systemic agents such as biologics, laser therapy stands in a class of its own. But laser treatment for psoriasis isn't the same as lasers used for cosmetic purposes like skin resurfacing. Instead, the laser in question, called the excimer laser, is a beam of light that targets areas of skin affected by psoriasis symptoms like plaques.

While harnessing the power of a laser for psoriasis can be an effective psoriasis treatment for mild to moderate psoriasis, according to the National Psoriasis Foundation, it's not a great idea for all types of psoriasis—nor is it the right option for all cases. With that, here's what you need to know about excimer laser therapy.

Laser Therapy 101

What Is Laser Therapy for Psoriasis?

Excimer laser therapy is the use of UVB light to treat psoriasis. "The excimer laser provides UVB light at a 308 nanometer wavelength to a localized area of skin which allows only 'affected,' or psoriatic skin to be treated without any injury to 'normal' skin," says dermatologist Gabriela Cobos, M.D., the director of the Dermatology-Rheumatology Program at Tufts Medical Center in Boston, MA. For context, the visible light emitted by the sun has wavelengths ranging from approximately 380-750 nanometers.

The UVB light emitted from the excimer laser targets the extra skin cells that are growing too quickly in people with psoriasis. When the laser shines on the skin, it helps to control these overactive skin cells. This makes them slowdown in their growth and can even stop them from growing too fast. As a result, the skin becomes healthier, less red, less itchy, and less scaly, says Dr. Cobos.

While sunlight has long been considered a particularly helpful salve for plaque psoriasis, it may do more harm than benefit when non-affected skin is also exposed, increasing the risk for sunburns and skin cancer. Laser treatment, which is targeted, offers a safer route. In fact, "the psoriatic plaque can take more energy [than normal skin]," says Jerry Bagel, M.D., a board-certified dermatologist at Windsor Dermatology in Windsor, NJ. "Since we are sparing normal skin with a laser, we can go faster—and get clear sooner."

Who Will Benefit From Excimer Lasers?

Since the excimer laser for psoriasis requires a hyper-focused beam, it works best for specific targets—and smaller surface areas. "Laser is good for localized areas, and less than 5% of the body," says Dr. Bagel. For instance, adds Dr. Cobos, it can be helpful if you only have psoriasis in one area, like the palms of the hands or on the scalp.

Ultimately, the ideal candidate is someone who has "psoriasis that is overall well controlled but has one or a few stubborn plaques that are not responding to topical therapy," she says.

Because it's indicated for small areas, sessions only last a few minutes, notes Dr. Cobos. However, "most patients will require two to three treatments per week, and will need multiple treatments until results are seen," she says.

The good news: According to research, targeted phototherapy with excimer laser appears to lead to longer remission (4-6 months longer) from psoriasis symptoms than traditional UVB.

Types of Psoriasis

Which Types of Psoriasis Can Excimer Lasers Treat?

Excimer lasers "are great for intertriginous regions [or areas with skin folds]," says Dr. Bagel, who notes that it can be helpful for areas like the crease under the breasts, the groin, and the armpit. Laser treatment for scalp psoriasis and psoriasis on the palms is also common, says Dr. Cobos.

Noticing a pattern here? These are all types of psoriasis that appear in small, isolated areas. And while it can help with your average plaque psoriasis on your arms or legs, "excimer therapy is best for patients with [psoriasis on a] limited surface area and not practical if the patient has extensive disease," she says.

How Well It Works

How Well Does Laser Treatment Work for Psoriasis?

Laser psoriasis treatment can be very effective. According to Dr. Cobos, it's possible to achieve remission with the excimer laser and only have to restart treatments in the event that lesions reappear. And research published in the journal Psoraisis found that after just four weeks of treatment with the excimer laser, people can generally get to a PASI (Psoriasis Area and Severity Index) of 75. This is approximately eight weeks sooner than people who were treated with etanercept (biologic) and UVB .

PASI is a measure of the severity of psoriasis. PASI 75 means that there's been a 75% improvement (or higher) from the baseline, and it's considered a great result.

Laser treatment is also an effective alternative to other medications. For instance, "it can also be a good treatment for patients who have contraindications to conventional psoriatic medications, including biologics," says Dr. Cobos. And it seems to work even better in combination with other therapies. One report in the International Journal of Hyperthermia found that pairing prescription topicals with laser therapy for psoriasis led to better clearance than the topicals alone. Specifically, only one person in the topical therapy regimen experienced partial psoriasis clearance. Meanwhile, 23 people experienced partial psoriasis clearance when using topical therapy and excimer laser treatment together.

How Much Does Excimer Laser Therapy for Psoriasis Cost?

On average, a single laser session can cost between $100 and $150, and multiple sessions are typically required for best results. Per XTRAC, a brand that sells excimer lasers, the treatment is typically covered by major insurance companies as well as Medicare, so it's unlikely you'll have to pay out of pocket (besides a co-pay, depending on your plan) if you're insured.

What to Know

What to Know Before Starting Laser Treatment

Excimer laser treatment for psoriasis isn't a good idea for everyone, especially those with sun sensitivities. According to Dr. Cobos, those who don't make a good candidate for it include:

People with xeroderma pigmentosum, a rare genetic condition that leads to a severe sensitivity to UV light
People with known photosensitivity disorders, such as lupus
People who are predisposed to skin cancer (whether through immunosuppression or genetic conditions)
People who are on photosensitizing medications
People with a history of multiple non-melanoma skin cancers, or melanoma

That said, it's not totally out of the question even with some of these contraindications, says Dr. Cobos. These individuals "should discuss the risks and benefits of therapy with their dermatologist," she says.

What Are the Risks of Laser Therapy?

The good news: With laser treatment for psoriasis, side effects are usually mild. "Overall laser therapy is quite safe, and treatments are usually well tolerated," says Dr. Cobos, who notes that the usual side effects include:

Blistering
Erythema, or redness
Hyperpigmentation
Local swelling

Fortunately, most of these reactions don't last, often resolving within 12 to 24 hours, says Dr. Cobos. "Rarely, patients can experience a severe burn which may result in hypopigmentation or hyperpigmentation and scarring," she says. But again, it's not common.

Outlook

While it's more unconventional than topical and systemic therapies, laser therapy can be a good option for small, stubborn areas of psoriasis—and one with relatively few side effects. Another advantage? In-office excimer laser treatments can be complemented with at-home devices, too. All to say: If you suspect you might be a good candidate for laser therapy, it's worth discussing with your dermatologist.

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