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Background: The Nd:YAG laser has emerged as a promising modality for the management of nail psoriasis owing to its ability for deep penetration of the skin surface, which has the advantage of destroying deep vessels. Objective: To assess the efficacy and safety of Nd:YAG laser in treating nail psoriasis. Methods: The present study was a randomized controlled study, conducted on 20 patients of both sexes (age older than 12 years) with mild to moderate psoriasis with nail involvement. We utilized facial telangiectasia parameters of Nd:YAG laser and beam diameter of 2.5 mm. Laser energy started with 110 J/cm2 in the first session and 130 J/cm2 in the rest of the sessions. Sessions were performed once monthly for up to 6 sessions. Results: We found no statistically significant difference in total Nail Psoriasis Severity Index (NAPSI) and nail bed scores before and after treatment among the treated group. However, there was statistically significant improvement in nail matrix score after treatment. On the other hand, the control group did not show any statistically significant changes for all scores throughout the study, except for the nail matrix score mean difference (0.35 ± 1.23 vs -1.00 ± 1.86 in the treated group). The degree of dermoscopic improvement was evident in the treated group (45% vs 25% in the control group). However, it was not statistically significant because of small sample size. The patients’ satisfaction and the external investigator’s assessment showed statistically significant negative correlation with total NAPSI mean difference in the treated group. Conclusion: The role of Nd:YAG laser in nail psoriasis is still controversial.

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Lichen Planus (LP) is a common T cell-mediated chronic inflammatory disease affecting skin & or mucous membranes. Also, T cellinduced autophagy is involved in the immunopathogenesis of the oral type of lichen planus (OLP). Beclin-1 is an autophagy marker with a critical role in the autophagic process. Heat shock proteins (HSP) synthesis increases in response to many stressors being the molecular chaperones. HSP has an important role in the Endoplasmic reticulum stress (ER stress) process. HSPs are assumed to be involved in the initiation and probably continuation of lichen planus through the autoimmune lymphocytic response. GRP78 (Glucose-regulated protein 78) is one of the HSPs that may play a substantial role in LP. ATF6 (activated transcription factor6) is one of ER stress pathway sensors that may link ER stress and autophagy. The study was conducted on 40 lichen planus patients and 20 healthy control subjects. GRP78, ATF6 and Beclin-1 gene expressions were estimated by real-time PCR. Patients with oral and cutaneous lichen planus showed a significant increase in GRP78, ATF6 and Beclin-1 compared to the normal control group. Conclusion; the results conduct an increase in autophagy and endoplasmic reticulum stress markers with lichen planus which may represent an inductive or protective mechanism for lichen planus.