the treated nails at month 3 and month 7 was highly statistically significant (P < 0.001) compared to pretreatment scores, and to control nails' scores (Paired t-test). The mean total NAPSI scores (AE standard deviation) at baseline, month 3 and month 7 in the control nails were 24.95 AE 5. 35, 26.95 AE 4.45 and 28.75 AE 4.69 respectively; whereas in the PDL-treated nails they were 25.45 AE 5.38, 15.40 AE 5.78 and 4.95 AE 4.03 respectively ( Fig.1and 2). The average decrease in total NAPSI scores within the 'PDL-treated nails' group from baseline to month 7 was 20.50 AE 4.87. There was no statistically significant difference between the nail bed response and the nail matrix response in the treated nails. The only reported adverse events were mild, transient pain in nine of the patients; and slight, transient purpura in all patients as purpuric doses were used.The present prospective, randomized, controlled study is the only study evaluating the effect of PDL on nail psoriasis in which the control nails did not receive any treatment, which adds to the strength of the study. The limitation of the study is the small number of patients and the lack of follow-up after the 7 th month. PDL resulted in an average decrease of 80% of NAPSI score. Oram and Akkaya 11 reviewed treatment options for nail psoriasis. Topical treatments like corticosteroids, tacrolimus, tazarotene, dithranol, 5-fluorouracil and cyclosporine resulted in improvement of NAPSI score of 51-88%. Targeting the vascular component of nail psoriasis by PDL seems to be an effective and safe approach. Applying PDL to the proximal nail fold and to the nail plate is essential to achieve equal improvement of nail matrix and nail bed lesions.

A detailed medical history and selective laboratory tests can illuminate etiologic factors in less than 40% of patients with chronic urticaria. Prognostic factors identified to impact the natural history of the disorder could be helpful when designing studies assessing the efficacy of therapeutic agents for chronic urticaria.

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