Nail psoriasis treated with intralesional methotrexate infiltration

Abstract

Psoriasis is a chronic inflammatory skin disease characterized by recurrent events. Its prevalence around the world is approximately 1-3%. 1,2 It´s estimated that 80-90% of patients with psoriasis will present with nail disorders throughout their lives. 2,3 Studies have shown that nail psoriasis is the causes a significant social problem, often associated with pain. 2 Different therapeutic options can be found for nail psoriasis, which include topical medication, intralesional treatment, systemic therapy, conventional therapies with immunobiological drugs, as well as non-pharmacological treatments. 2,3 Methotrexate (MTX) is a folic acid analogue, responsible for inhibiting the synthesis of deoxyribonucleic acid. 2,3 A literature review shows that intralesional MTX has been successfully used for several indications with no complications reported. The treatment of nail psoriasis has still yielded unsatisfactory results, leading doctors to search for more effective therapeutic approaches. 2 Case 1. We report a 45-year-old female patient with nail dystrophy for 2 years referred for onychomycosis treatment. She presented with exuberant subungual hyperkeratosis and discrete cupuliform depressions, in addition to erythema, periungual edema, and pain in the right hallux (Figure 1). No changes were observed in the other nails. We observed no other alterations on physical examination. Direct mycological examination, repeated weekly for 4 weeks, was always negative. MRI of the hallux confirmed the

Fractional CO2 Laser-Assisted Delivery Versus Intralesional Injection of Methotrexate in Psoriatic Nails

“…Triamcinolone acetonide was the most commonly injected drug in nail psoriasis. 3 Intralesional injection of methotrexate in psoriatic nails was addressed in individual case reports 4,5 and few large-scale studies. 2,3 Methotrexate is a folic acid analog, responsible for inhibiting the synthesis of DNA with a direct toxic effect on keratinocytes.…”

“…Intralesional injection of methotrexate has been successfully used in the treatment of recalcitrant nail psoriasis in previous reports. [2][3][4][5] The local injection of the drug may avoid the need for systemic treatment and help deliver the drug in high concentrations into the nail matrix. 3 Although intramatricial injection is a safe and effective modality, pain is still the major side effect which can greatly decrease patient compliance, especially in patients with multiple digits involvement.…”

Treatment with intralesional methotrexate injection in a patient with nail psoriasis

“…Mokni and Duarte reported progressive improvement in nail dystrophy with intralesional MTX injection in nail psoriasis [9,10]. Mittal et al reported that intralesional methotrexate and corticosteroid injections show similar efficacy in nail psoriasis.…”

Efficacy of intralesional methotrexate in the treatment of plantar warts

“…A literature review shows that intralesional MTX has been successfully used for several indications with no complications reported (Duarte, Carneiro, Murari, & Jesus, ). Unlike oral MXT, topical preparations of the drug, that was adapted for the treatment of localized lesions, showed nonsignificant related hepatotoxic and hematologic adverse effects (Sutton, Swinehart, Cato, & Kaplan, ).…”