THERAPEUTIC MODALITIES FOR PSORIASIS: 308-NM EXCIMER LASER ALONE VERSUS METHOTREXATE PLUS EXCIMER LASER

Background: Psoriasis is a chronic immune-mediated inflammatory skin disease that significantly affects patients' quality of life and is associated with substantial physical and psychological morbidity. Although methotrexate remains a standard systemic therapy for moderate-to-severe psoriasis, targeted phototherapy using the 308-nm excimer laser has emerged as a promising therapeutic alternative with localized treatment and a favorable safety profile. Objective: To compare the efficacy of 308-nm excimer laser alone versus methotrexate plus 308-nm excimer laser in patients with generalized psoriasis. Methods: This randomized controlled trial was conducted in the Department of Dermatology, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana. A total of 90 patients with moderate-to-severe generalized psoriasis were enrolled and randomly allocated into two equal groups. Group A received 308-nm excimer laser monotherapy, whereas Group B received oral methotrexate combined with 308-nm excimer laser. Patients were followed for three months. Treatment efficacy was defined as a ≥50% reduction in Psoriasis Area and Severity Index (PASI) score from baseline. Data were analyzed using SPSS version 24.0, with a p-value ≤0.05 considered statistically significant. Results: Ninety participants completed the study, with 45 patients in each treatment group. Both treatment modalities resulted in significant clinical improvement during follow-up. A greater proportion of patients receiving 308-nm excimer laser alone achieved treatment efficacy compared with those receiving methotrexate plus excimer laser. Mean PASI scores progressively decreased from baseline to three months in both groups, with greater improvement observed in the excimer laser group. No serious treatment-related adverse events requiring discontinuation were reported. Conclusion: Both treatment modalities were effective in improving psoriasis severity; however, 308-nm excimer laser monotherapy demonstrated a higher treatment response than methotrexate combined with excimer laser. Targeted phototherapy may represent an effective therapeutic option for patients with generalized psoriasis. Larger multicenter studies with extended follow-up are warranted to validate these findings