Comparative Clinical Outcomes of Fractional CO₂ Laser-Assisted Topical Therapy for Nail Psoriasis: A Systematic Review

Fractional carbon dioxide (FCO₂) laser-assisted topical therapy has been investigated to enhance drug delivery in nail psoriasis, but improvement from baseline does not establish whether laser pretreatment provides additional clinical benefit.This systematic review evaluated the comparative efficacy, safety, tolerability, and durability of FCO₂-assisted topical therapy.PubMed/MEDLINE, Scopus, and Web of Science were searched from inception through September 18, 2026.Comparative controlled studies were eligible, and risk of bias was assessed using the Cochrane RoB 2 tool.Five studies involving 134 participants were included.Three compared FCO₂-assisted topical therapy with the same topical agent alone, one compared two FCO₂-assisted topical regimens, and one compared laser-assisted topical corticosteroid therapy with intralesional corticosteroid treatment.Although nail severity improved over time across studies, direct comparative effects were inconsistent and varied by topical agent, comparator, and assessment time.Between-treatment advantages were observed in selected tazarotene and methotrexate comparisons, whereas other comparisons showed no clear incremental benefit.Laser-assisted corticosteroid treatment achieved broadly comparable short-term outcomes to intralesional therapy with less procedural pain and greater patient satisfaction.Four of five principal efficacy results were at high risk of bias, and one raised some concerns.Meta-analysis was not appropriate because of substantial heterogeneity.Current evidence does not establish a consistent incremental efficacy advantage of laser assistance.More rigorous, adequately powered trials with appropriate paired analyses and standardized follow-up are needed before routine adjunctive use can be recommended.