Psoriatic nails: Study supports intramatrix triamcinolone therapy

Key Points

International report - In a recent study, intramatrix injections of triamcinolone acetonide (TA) have proven safe and effective for treating psoriatic fingernails, says study co-author Kaur Savreet, M.D., a dermatologist who specializes in skin and sexually transmitted diseases, and a medical officer with the Government of Punjab, India, Department of Health.

Dr. Savreet says that, presently, physicians use varying concentrations of TA to treat psoriatic fingernails, but no standards for dosing or treatment regimens exist.

"There's been little research done on this topic," Dr. Savreet says.

As a result, Dr. Savreet says, "Physicians are usually afraid of using intramatrix injections. Maybe some of them don't know the technique," and others might fear that intramatrix injections of steroids will cause nail fold atrophy.

Therefore, she says, "We need to inject the drug into the nail bed or nail matrix for effective results."

Study parameters

To compare and clinically validate the performance of various TA concentrations, Dr. Savreet and a colleague enrolled patients with a total of 90 psoriatic fingernails as a thesis project while Dr. Savreet was pursuing her M.D. credentials at the Government Medical College, Amritsar, India.

Investigators assessed each nail using the Nail Psoriasis Severity Index (Rich P, Scher RK. J Am Acad Dermatol. 2003 Aug;49(2):206-212) and divided the nails randomly into three groups of 30.

They treated patients in group A with TA 2.5 mg/ml, those in group B with 5 mg/ml and those in group C with 10 mg/ml. All patients received two intramatrix injections per nail, totaling 0.1 ml of solution at each sitting, Dr. Savreet tells Dermatology Times.

"I used three doses total, spaced six weeks apart. With the concentration of 10 mg/ml, I got good results," she says.

Dr. Savreet also took clinical photographs every six weeks for up to six months. Using these photos, investigators assessed improvement in pitting, discoloration and other parameters using a four-grade scale (grade 1= up to 25 percent improvement; 4= greater than 75 percent improvement).