Corticosteroid-induced ‘disappearing digit’

Wolf, Ronni; Tur, Ethel; Brenner, Sarah

doi:10.1016/s0190-9622(08)81079-1

Cited by 38 publications

(25 citation statements)

References 2 publications

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“…Many topical agents have been used with various local side effects; also atrophy of the underlying phalanx known as disappearing digit was reported due to chronic use of topical steroids [8]. These reported side effects limited their usage.…”

Section: Discussionmentioning

confidence: 99%

Nail Psoriasis Successfully Treated with Intralesional Methotrexate: Case Report

Sarıcaoğlu

Turan³

2011

Dermatology

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Psoriasis is a common, chronic disease which affects nearly 3% of the population. The lifetime incidence of nail involvement increases up to 80–90% for psoriatic patients. Nail psoriasis is considered a significant social problem. Many topical agents have been used for psoriatic nails with various side effects and some benefits; management is currently inconclusive. Methotrexate (MTX) is a folic acid analog, which irreversibly binds to dehydrofolate reductase and blocks deoxyribonucleic acid synthesis. It is considered a potential treatment option for rapidly growing cells and has an anti-inflammatory effect through inhibition of the polyamine pathway in autoimmune diseases. Intralesional MTX has been used successfully for various indications. We present a case successfully treated with low-dose intralesional MTX with no observed side effects in a 26-year-old female psoriatic patient suffering from nail dystrophy. In contrast, conventional topical and systemic therapies have various side effects, which limit their use. We conclude that intralesional MTX injection seems to be a safe and effective treatment option for nail psoriasis; however, large controlled studies are needed.

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Section: Discussionmentioning

confidence: 99%

Nail Psoriasis Successfully Treated with Intralesional Methotrexate: Case Report

Sarıcaoğlu

Turan³

2011

Dermatology

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“…[3][4][5][6] Topical calcipotriol therapy has been successfully used for chronic plaque psoriasis 7 and, according to our recent experience, may considerably improve nail bed psoriasis. This is especially true when psoriasis produces massive hyperkeratosis of the nail bed and hyponychium, resulting in severe nail thickening.…”

Section: Discussionmentioning

confidence: 99%

Calcipotriol ointment in nail psoriasis: a controlled double-blind comparison with betamethasone dipropionate and salicylic acid

Tosti

Piraccini

Cameli

et al. 1998

British Journal of Dermatology

119

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This double-blind randomized study was designed to compare the efficacy and safety of calcipotriol ointment (50 microg/g) with betamethasone dipropionate (64 mg/g) and salicylic acid (0.03 g/g) ointment in the treatment of nail bed psoriasis. Fifty-eight patients applied the given drug to the affected nails twice a day for 3-5 months, depending on clinical response. Efficacy was assessed monthly on the basis of nail thickness, measured in millimetres. Photographs of the treated nails were taken at baseline, and after 3 and 5 months. Tolerability was assessed at 3 and 5 months. In patients with fingernail psoriasis, after 3 months of treatment subungual hyperkeratosis was reduced from 2.3 +/- 0.1 mm (mean +/- SEM) to 1.5 +/- 0.1 mm (-26.5%) in the calcipotriol group and from 2.3 +/- 0.1 mm to 1.6 +/- 0.1 mm (-30.4%) in the betamethasone dipropionate and salicylic acid group [not significant (NS) between treatments, analysis of variance (ANOVA)]. After 5 months, responders showed a 49.2% reduction in hyperkeratosis in the calcipotriol group (from 2.8 +/- 0.1 mm to 1.4 +/- 0.2 mm) and 51.7% (from 2.1 +/- 0.1 mm to 1.0 +/- 0.1 mm) in the betamethasone dipropionate and salicylic acid group (P < 0.001 from baseline, NS between treatments, ANOVA). In patients with toenail psoriasis, after 3 months of treatment there was an overall reduction in hyperkeratosis from 2.6 +/- 0.1 mm to 2.1 +/- 0.1 mm (-20.1%) in the calcipotriol group and from 3.0 +/- 0.1 mm to 2.3 +/- 0.1 mm (-22. 9%) in the betamethasone dipropionate and salicylic acid group (P < 0.001 from baseline, NS between treatments, ANOVA). By the end of the fifth month there was a 40.7% reduction in hyperkeratosis in the calcipotriol group (from 2.1 +/- 0.1 mm to 1.2 +/- 0.1 mm) and 51.9% in the betamethasone dipropionate and salicylic acid group (from 2.7 +/- 0.1 mm to 1.3 +/- 0.1 mm; P < 0.0001 from baseline, NS between treatments, ANOVA). The results of the study show that calcipotriol is as effective as a combination of a topical steroid with salicylic acid in the treatment of nail psoriasis and represents a safe alternative in the topical treatment of nail psoriasis.

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“…Furthermore, a number of studies have documented a possible tapering of the treated digit, which is caused by atrophy of the underlying phalanx and is commonly known as ''disappearing digit.'' [57][58][59] Aside from these problems, other adverse effects include striae formation, development of telangectasias, tachyphylaxis, and potential systemic absorption of the steroid. With respect to the above studies, the only adverse reaction attributed to steroid application was seen in the investigation by Tosti et al, 55 in which there were 3 cases of erythema.…”

Section: Topical Therapymentioning

confidence: 99%

“…99,100 The chronic nature of the disease often requires repeated courses of the steroid, which can lead to reversible atrophy at the injection site 98,99 and potential atrophy of the underlying terminal phalanx, a condition known as ''disappearing digit.'' [57][58][59] Other complications, such as collagen atrophy and rupture of the extensor tendon, are only theoretical possibilities, because there are no well-documented cases of these events. 54 With respect to the needleless injectors, one study reported a puncture of the nail plate.…”

Section: Intralesional Therapymentioning

confidence: 99%

Psoriasis of the nail: Anatomy, pathology, clinical presentation, and a review of the literature on therapy

Jiaravuthisan

Sasseville

Vender

et al. 2007

Journal of the American Academy of Dermatology

361

382

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Corticosteroid-induced ‘disappearing digit’

Cited by 38 publications

References 2 publications

Nail Psoriasis Successfully Treated with Intralesional Methotrexate: Case Report

Nail Psoriasis Successfully Treated with Intralesional Methotrexate: Case Report

Calcipotriol ointment in nail psoriasis: a controlled double-blind comparison with betamethasone dipropionate and salicylic acid

Psoriasis of the nail: Anatomy, pathology, clinical presentation, and a review of the literature on therapy

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