BACKGROUND Nail psoriasis has a major negative impact on physical and psychological aspects of the patient’s Treatment is often unsatisfactory because of difficult penetration of the drug into the nail. OBJECTIVE To evaluate and compare the efficacy of laser-assisted delivery of methotrexate versus its intralesional injection in fingernail psoriasis. MATERIALS AND METHODS Twenty-eight patients with fingernail psoriasis were divided into 2 groups of 14 patients each. Group A was treated with intralesional injection of methotrexate while Group B received fractional CO2 laser followed by topical application of methotrexate. The treatment was given at a 2-week interval for 6 sessions. The im- provement of nail psoriasis was assessed by clinical and dermoscopic evaluation. RESULTS At the end of treatment, both laser-assisted delivery and intralesional injection of methotrexate were associated with statistically significant improvement of psoriatic signs. No statistically significant difference was found between the 2 groups regarding total nail psoriasis severity Index (p 5 .18), matrix score (p 5 .38), bed score (p 5 .23), and dermoscopic score (p 5 .78). However, the pain and subungual hematoma were significantly less in the laser group (p , .001 and p 5 .03, respectively). CONCLUSION Fractional CO2 laser-assisted delivery of methotrexate can be an effective and well-tolerated alternative to intralesional injection in nail psoriasis.