A simplified protocol of steroid injection for psoriatic nail dystrophy

The British Journal of Dermatology
D de Berker, C M Lawrence

Abstract

Subjects seeking therapy for psoriatic nail dystrophy were recruited from routine clinics and involved digits were scored between 0 and 3 for severity of each of five features: subungual hyperkeratosis, pitting, onycholysis, ridging and thickening. These features were re-scored 2 months after injection of triamcinolone acetonide (0.4 mL, 10 mg/mL) into the nail bed and matrix following ring block, and then at 3-monthly intervals. A second injection was offered at 2 months if warranted by poor response. Forty-six digits were injected in 19 subjects (12 women, 7 men, mean age 48 years) receiving a mean of 1.2 doses. Follow-up ranged from 3 to 17 months (mean 9.4). Results are given for responses sustained up until the last follow-up. Onycholysis was present in 36 digits (78%) and improved in 18 (50%) of these. Pitting was present in 20 (43%), improving in nine (45%) and remaining unchanged in 11 (55%). Subungual hyperkeratosis was present in 16 (35%) and always improved after injection. Ridging was also present in 16 (35%) and improved in all but one instance. Thickening was present in 12 cases (26%), improving in 10 (83%) and remaining unchanged in the rest. Although onycholysis and pitting are the most common elements of psoria...Continue Reading

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