EVALUATION OF A SIMPLIFIED PROTOCOL OF STEROID INJECTIONS FOR NAIL PSORIASIS

Simplified Protocol of Steroid Injections for Nail Psoriasis

Abstract

Objective: To evaluate the efficacy of a modified regimen of intralesional steroid injection therapy for the treatment of nail psoriasis and to assess the side effects of this regimen.
Design: Quasi-experimental study.
Place and Duration of Study: Dermatology department of Military Hospital Rawalpindi from Feb 1999 to Jan 2001.
Patients and Methods: Patients having psoriatic nail dystrophy, reporting in skin department of Military Hospital Rawalpindi were registered. The features accounted for were pitting, onycholysis, subungual hyperkeratosis, ridging, thickening and color change. Injection of Triamcinolone acetenoid (10mg/ml) was given into the nail bed and matrix following ring block anesthesia. A second injection was given after 02 months if warranted by poor response. The follow up period ranged upto 06 months.
Results: Eighty three digits were injected in 35 subjects. Pitting was the commonest presenting feature seen in 71 (85.5%) digits and improved in 51 (71.8%) digits. Onycholysis was seen in 37 (44.6%) digits and improved in 25 (67.6%) digits. Subungual hyperkeratosis was seen in 57 (68.7%) digits and improved in all cases. Other features like longitudinal ridging, thickening and yellow oil drop like discoloration also improved considerably. The side effects of this regimen were minimal.
Conclusion: This regimen has been found to be effective and safe for the treatment of psoriatic nail dystrophy.