Distal phalangeal atrophy secondary to topical steroid therapy

Deffer, T. A.

doi:10.1001/archderm.123.5.571b

Cited by 13 publications

(14 citation statements)

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“…However, as nail psoriasis is a chronic condition that requires long-term treatment, topical steroids in this condition may not be a safe treatment, as long-term topical application of these drugs may possibly result in atrophy of the digits or even in focal bone resorption. [4][5][6] We therefore believe that topical calcipotriol is a safe alternative in the topical treatment of nail bed psoriasis.…”

Section: Discussionmentioning

confidence: 98%

“…1,2 Most dermatologists treat nail psoriasis with intralesional or topical steroids, which usually improve the nail symptoms, but require continuous application and may cause significant side-effects. [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. 8,9 This drug has also been utilized for treating pustular psoriasis and Hallopeau's chronic acrodermatitis continua.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 98%

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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“…[1] Furthermore, with persistent use of very potent topical steroids over years, a number of studies have documented a possible tapering of the treated digit, which can be caused by atrophy of the underlying phalanx and is commonly known as “disappearing digit”. [636465]…”

Section: Treatment Of Nail Psoriasismentioning

confidence: 99%

Nail psoriasis: The journey so far

Dogra

Arora

2014

Indian J Dermatol

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Nail involvement is an extremely common feature of psoriasis and affects approximately 10-78% of psoriasis patients with 5-10% of patients having isolated nail psoriasis. However, it is often an overlooked feature in the management of nail psoriasis, despite the significant burden it places on the patients as a result of functional impairment of manual dexterity, pain, and psychological stress. Affected nail plates often thicken and crumble, and because they are very visible, patients tend to avoid normal day-to-day activities and social interactions. Importantly, 70-80% of patients with psoriatic arthritis have nail psoriasis. In this overview, we review the clinical manifestations of psoriasis affecting the nails, the common differential diagnosis of nail psoriasis, Nail Psoriasis Severity Index and the various diagnostic aids for diagnosing nail psoriasis especially, the cases with isolated nail involvement. We have also discussed the available treatment options, including the topical, physical, systemic, and biological modalities, in great detail in order to equip the present day dermatologist in dealing with a big clinical challenge, that is, management of nail psoriasis.

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“…We chose to treat this patient with nimesulide because of our favourable experience with its use in 4. Histology shiiws aciinthosis with papillniiiiUosis.…”

Section: Smentioning

confidence: 99%

Psoriasiform and sclerodermoid dermatitis of the fingers with apparent shortening of the nail plate: a distinct entity?

Caputo¹,

Gelmetti²,

Grimalt³

et al. 1996

Br J Dermatol

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A Caucasian boy, born to unrelated parents, and with no family history of psoriasis or atopy, developed chronic psoriasiform dermatitis on the palmar surface of the fingers when he was a year old. At the age of 6, the dorsal surface acquired a sclerodermoid appearance and the nail plates appeared to be shortened. The disease was unsuccessfully treated topically with emollients, keratolytic agents and corticosteroids. At the age of 9, when he was hospitalized, finger motility was limited and painful, and movements of the hands were impaired. The feet were normal. All the investigations were within normal limits. Histology of a biopsy revealed parakeratosis, acanthosis with papillomatosis, exocytosis and spongiosis. He was treated with a new oral non-steroidal anti-inflammatory drug, nimesulide (100 mg/day for 20 days, and then 50 mg/day for 20 days), and emollients. Marked improvement, and restoration of finger motility, were achieved after the first month of treatment; the nail plates reappeared because of regression of the eponychium.

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Distal phalangeal atrophy secondary to topical steroid therapy

Cited by 13 publications

References 0 publications

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

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

Nail psoriasis: The journey so far

Psoriasiform and sclerodermoid dermatitis of the fingers with apparent shortening of the nail plate: a distinct entity?

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