الفهرس 
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Abstract
Psoriasis is a chronic immune-mediated skin disease with pathogenesis resulting from combination of genetic and environmental factors. The pathogenesis of psoriasis is driven by the interaction between innate and adaptive immune cells and keratinocytes, in a complex process mediated by cytokines and other signaling molecules. This leads to an inflammatory process with increased proliferation of epidermal cells, neo-angiogenesis and infiltration of white cells in the skin which cause the characteristic psoriasis plaques. Approximately 80 % of persons with psoriasis have ”psoriasis vulgaris”. Plaque psoriasis is the most common type and can appear on any skin surface, although the knees, elbows, scalp, trunk and nails are the most common locations. There are several other types of psoriasis and between 10 % and 30 % of people with psoriasis also develop psoriatic arthritis. Treatment of psoriasis depends on the severity of the disease. The majority of psoriatic patients present with mild or localized disease that can be treated with topical medications such as corticosteroids, vitamin D analogs, retinoids, anthralin, or tar. When these topical treatments are found to be ineffective, the next level of therapy entails the use of phototherapy, systemic medications, or biologics. Of these, phototherapy remains an attractive option because of its efficacy and cost effectiveness. Localized phototherapy offers the advantage of subjecting skin lesions to significantly high doses of radiation while sparing nearby uninvolved skin. Cold laser is a non-invasive light source treatment that generates single wavelength of light. It emits no heat, sound, or vibration. It is also called low level laser therapy or bio stimulation. Although the skin is the organ that is naturally exposed to light more than any other organ, it still responds well to red and near-infrared wavelengths. Wavelengths between 660 nm and 905 nm have the ability to penetrate skin and soft/hard tissues. This light has a good effect on pain, inflammation and tissue repair. This study aimed to evaluate clinically and microscopically the efficacy of cold laser therapy in the treatment of localized plaque psoriasis.. Patients and Methods This study was carried out on 40 patients with localized psoriasis who attended to Outpatient Clinic of Dermatology and Venereology Department, Tanta University Hospital. Methods: All patients were subjected to: 1.Compelete history taking. 2. General and dermatological examinations. 3. Plaque severity score estimation before and after the end of treatment. 4. Dermoscopic examination before and after the end of treatment to evaluate the efficacy of treatment. 5. Histopathological examination before and after the end of treatment for some cases only. • The biopsy was examined by: • Light Microscope (H&E and toluidine blue). • Transmission electron microscope. 6- Therapeutic modality: The psoriatic lesions in all patients were subjected to cold laser therapy 808 nm wavelength. Patients received one session twice weekly separated by 2 days for a maximum of 8 weeks. Photos were taken to the lesions before and after end of treatment to compare the effect of treatment. Follow up was done monthly for 3 months after end of treatment. The results of the study revealed that: The age of patients ranged from 22 to 60 years with mean ±SD was 42.68± 10.62years and median was 42 years. The most common presented age group was 50-60 years group (32.5%) followed by 30-<40 years and 40-<50 years representing 27.5%. Total number of diseased males were 28 (70%) and total number of affected females were 12 (30%) with Male: Female ratio was2.33:1. The duration of disease ranged from 1 to 20 years with mean ±SD was 5.63± 3.97 years. Five patients (12.5%) had positive family history of psoriasis. The most common site was extremities representing 87.5% of studied cases. Regarding clinical efficacy ,Before treatment ,the mean (±SD) of plaque severity score was 6.0 (±1.52) and ranged from 4 to 9. After treatment, score ranged from 0 to 9 and the mean (±SD) was 1.85 (±1.93). There was statistically significant decrease in plaque severity score after end of treatment in the studied patients. (p<0.001) and the percentage of reduction in plaque severity score after end of treatment was 69.16%. There was significant clinical improvement of erythema, induration and scales in most of patients scores after end of treatment in the studied patients (p<0.001). Regarding dermoscopic findings , there was statistically significant decrease in the percentage of patients showing dermoscopic changes including red dots after end of treatment . Regarding patients’ satisfaction , most of patients were satisfied from the results after end of treatment. Regarding side effects , two patients (5%) had residual hyperpigmentation after end of cold laser therapy and seven patients (17.5 %) showed recurrence of psoriasis during follow up which was done monthly for three months. While, three patients (7.5%) reported burning sensation during sessions . There was statistically significant positive correlation between plaque severity score after end of treatment and age , duration of disease and dermoscopic changes. This means that younger patients with shorter duration of disease and minimal dermoscopic changes before treatment showed more decrease in plaque severity score after end of treatment than old patients with long duration of disease and excess dermoscopic changes (p=0.013) , (p<0.001) and (p= 0.000) respectively. However ,there was non statistically significant correlation between plaque severity score after end of treatment and positive family history. Degree of clinical improvement based on reduction in plaque severity score after end of treatment as there was inverse relation between degree of clinical improvement and plaque severity score after end of treatment (p<0.001). Degree of clinical improvement was statistically significant higher in age group less than 30 years than others more than 30 years (p<0.001). Degree of clinical improvement (excellent and good) was statistically higher in patients with short duration of disease than others with long duration of disease (p=0.001) . There was non-significant relation between degree of clinical improvement and each of gender, site of lesion as well as positive family history (p>0.05). Clinical improvement was supported by histopathological examination for some cases only , examination was done by light and transmission electron microscope. Light microscope examination after the end of treatment showed disappearance of parakeratosis ,decrease thickness of epidermis with flattening of dermoepidermal junction and decrease dermal inflammatory infiltrate. Transmission electron microscope examination after the end of treatment showed normal looking keratinocytes close to each other‘s containing melanin granules and the underlying dermis showed collagen fibers without inflammatory cells . So, there was significant improvement according to histopathological examination after end of treatment . Based on our results we recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion.