Triamcinolone Acetonide Injections in Nail Psoriasis: A Pragmatic Analysis

Overview

Journal Skin Appendage Disord

Specialty Dermatology

Date 2024 Feb 5

PMID 38313569

Authors

Chander Grover

Geetali Kharghoria

Shikha Bansal

Affiliations

Soon will be listed here.

Abstract

Introduction: Treatment of nail psoriasis is challenging. Systemic therapies may be difficult to justify, while topical therapies may be sup-optimal. Triamcinolone acetonide (TA) injections are recommended as first-line therapy in cases with less than 3 nails involved; however, limited studies are available. This study was conducted to evaluate the reduction in NAPSI (Nail Psoriasis Severity Index) with TA injections in patients with isolated nail psoriasis.

Methods: A retrospective case record analysis of efficacy and safety of TA (5 mg/mL) nail injections (4-weekly for fingernails, 8-weekly for toenails) was done in 10 patients. NAPSI was evaluated at each visit and treatment endpoint (75% reduction or 10 injections, whichever was earlier). Dropouts and adverse effects were recorded.

Results: Among 10 patients (94 involved nails, 61 fingernails, and 33 toenails), 3 patients (30%) dropped out (2, 4, and 5 sessions, respectively), citing procedural pain. Three patients achieved NAPSI-75 (3, 6, and 7 sessions, respectively). Baseline mean NAPSI of 5.03 (4.63 fingernails and 5.78 toenails) dropped to 3.67 (3.13 fingernails and 4.42 toenails) by the 5th injection; and 2.35 (2.13 fingernails and 2.59 toenails) by the 10th injection. Adverse effects included pain (30%), subungual haematoma (1.7%), and proximal nail fold hypopigmentation with mild atrophy (1.1%).

Conclusions: TA (5 mg/mL) injections are effective in nail psoriasis and associated with minimal adverse effects.

References

Saleem K, Azim W . Treatment of nail psoriasis with a modified regimen of steroid injections. J Coll Physicians Surg Pak. 2008; 18(2):78-81. DOI: 02.2008/JCPSP.7881. View

Ortonne J, Baran R, Corvest M, Schmitt C, Voisard J, Taieb C . Development and validation of nail psoriasis quality of life scale (NPQ10). J Eur Acad Dermatol Venereol. 2010; 24(1):22-7. DOI: 10.1111/j.1468-3083.2009.03344.x. View

Rich P, Griffiths C, Reich K, Nestle F, Scher R, Li S . Baseline nail disease in patients with moderate to severe psoriasis and response to treatment with infliximab during 1 year. J Am Acad Dermatol. 2007; 58(2):224-31. DOI: 10.1016/j.jaad.2007.07.042. View

Starace M, Alessandrini A, Iorizzo M, DAltobrando A, Ferrari T, Bruni F . A pilot study of intralesional methotrexate injections versus triamcinolone acetonide in patients affected by nail matrix psoriasis. Clin Exp Dermatol. 2022; 47(6):1165-1168. PMC: 9303444. DOI: 10.1111/ced.15110. View

Rigopoulos D, Baran R, Chiheb S, Daniel 3rd C, Di Chiacchio N, Gregoriou S . Recommendations for the definition, evaluation, and treatment of nail psoriasis in adult patients with no or mild skin psoriasis: A dermatologist and nail expert group consensus. J Am Acad Dermatol. 2019; 81(1):228-240. DOI: 10.1016/j.jaad.2019.01.072. View

Grover C, Bansal S, Nanda S, Nagi Reddy B . Efficacy of triamcinolone acetonide in various acquired nail dystrophies. J Dermatol. 2006; 32(12):963-8. DOI: 10.1111/j.1346-8138.2005.tb00882.x. View

Yoo K, Bang D, Han H, Li K, Kim B . Intralesional triamcinolone injections for the treatment of nail dystrophy: A case series. Dermatol Ther. 2020; 33(3):e13427. DOI: 10.1111/dth.13427. View

de Vries A, Bogaards N, Hooft L, Velema M, Pasch M, Lebwohl M . Interventions for nail psoriasis. Cochrane Database Syst Rev. 2013; (1):CD007633. PMC: 11611064. DOI: 10.1002/14651858.CD007633.pub2. View

de Berker D, Lawrence C . A simplified protocol of steroid injection for psoriatic nail dystrophy. Br J Dermatol. 1998; 138(1):90-5. DOI: 10.1046/j.1365-2133.1998.02031.x. View

10.

Nantel-Battista M, Richer V, Marcil I, Benohanian A . Treatment of nail psoriasis with intralesional triamcinolone acetonide using a needle-free jet injector: a prospective trial. J Cutan Med Surg. 2014; 18(1):38-42. DOI: 10.2310/7750.2013.13078. View

11.

Belyayeva E, Gregoriou S, Chalikias J, Kontochristopoulos G, Koumantaki E, Makris M . The impact of nail disorders on quality of life. Eur J Dermatol. 2013; 23(3):366-71. DOI: 10.1684/ejd.2013.2048. View

12.

Iorizzo M, Di Chiacchio N, Di Chiacchio N, Grover C, Lipner S, Richert B . Intralesional steroid injections for inflammatory nail dystrophies in the pediatric population. Pediatr Dermatol. 2023; 40(4):759-761. DOI: 10.1111/pde.15295. View

13.

Grover C, Bansal S . A Compendium of Intralesional Therapies in Nail Disorders. Indian Dermatol Online J. 2018; 9(6):373-382. PMC: 6232991. DOI: 10.4103/idoj.IDOJ_280_18. View

14.

Boontaveeyuwat E, Silpa-Archa N, Danchaivijitr N, Wongpraparut C . A randomized comparison of efficacy and safety of intralesional triamcinolone injection and clobetasol propionate ointment for psoriatic nails. J Dermatolog Treat. 2018; 30(2):117-122. DOI: 10.1080/09546634.2018.1476647. View

15.

Brazzelli V, Carugno A, Alborghetti A, Grasso V, Cananzi R, Fornara L . Prevalence, severity and clinical features of psoriasis in fingernails and toenails in adult patients: Italian experience. J Eur Acad Dermatol Venereol. 2011; 26(11):1354-9. DOI: 10.1111/j.1468-3083.2011.04289.x. View

16.

Iorizzo M, Tosti A, Starace M, Baran R, Daniel 3rd C, Di Chiacchio N . Isolated nail lichen planus: An expert consensus on treatment of the classical form. J Am Acad Dermatol. 2020; 83(6):1717-1723. DOI: 10.1016/j.jaad.2020.02.056. View

17.

Singh S . Finger nail pitting in psoriasis and its relation with different variables. Indian J Dermatol. 2013; 58(4):310-2. PMC: 3726881. DOI: 10.4103/0019-5154.113955. View

18.

Augustin M, Reich K, Blome C, Schafer I, Laass A, Radtke M . Nail psoriasis in Germany: epidemiology and burden of disease. Br J Dermatol. 2010; 163(3):580-5. DOI: 10.1111/j.1365-2133.2010.09831.x. View

19.

Rich P, Scher R . Nail Psoriasis Severity Index: a useful tool for evaluation of nail psoriasis. J Am Acad Dermatol. 2003; 49(2):206-12. DOI: 10.1067/s0190-9622(03)00910-1. View

20.

Jiaravuthisan M, Sasseville D, Vender R, Murphy F, Muhn C . Psoriasis of the nail: anatomy, pathology, clinical presentation, and a review of the literature on therapy. J Am Acad Dermatol. 2007; 57(1):1-27. DOI: 10.1016/j.jaad.2005.07.073. View