Effects of pulsed dye laser treatment in psoriasis: A nerve‐wrecking process?

• Published in: Experimental dermatology 2023-07, Vol.32 (7), p.1165-1173
• Main Authors: Doppegieter, Meagan, Beek, Nick, Bakker, Erik N. T. P., Neumann, Martino H. A., Bavel, Ed
• Format: Article
• Language: English
• Subjects: Cell activation; Cell adhesion molecules; Denervation; Dyes; Inflammation; Innervation; Nerves; perivascular nerves; Psoriasis; pulsed dye laser; Remission
• ISSN: 0906-6705; 1600-0625
• DOI: 10.1111/exd.14816

Pulsed dye laser (PDL) therapy can be effective in treating psoriasis, with a long duration of remission. Although PDL therapy, albeit on a modest scale, is being used for decades now, the underlying mechanisms responsible for the long‐term remission of psoriasis remain poorly understood. The selective and rapid absorption of energy by the blood causes heating of the vascular wall and surrounding structures, like perivascular nerves. Several studies indicate the importance of nerves in psoriatic inflammation. Interestingly, denervation leads to a spontaneous remission of the psoriatic lesion. Among all dermal nerves, the perivascular nerves are the most likely to be affected during PDL treatment, possibly impairing the neuro‐inflammatory processes that promote T‐cell activation, expression of adhesion molecules, leukocyte infiltration and cytokine production. Repeated PDL therapy could cause a prolonged loss of innervation through nerve damage, or result in a ‘reset’ of neurogenic inflammation after temporary denervation. The current hypothesis provides strong arguments that PDL treatment affects nerve fibres in the skin and thereby abrogates the persistent and exaggerated inflammatory process underlying psoriasis, causing a long‐term remission of psoriasis. The effect of PDL therapy in remission of psoriasis is largely unkown. The selective absorption of energy by the blood causes heating of the vascular wall and surrounding structures like (perivascular nerves), possibly impairing the neuro‐inflammatory processes that promote T‐cell activation, expression of adhesion molecules, leukocyte infiltration and cytokine production.