Efficacy of Triamcinolone Acetonide in Various Acquired Nail Dystrophies

Abstract

The treatment of nail disorders is currently an unsatisfying exercise. Isolated nail involvement generally does not warrant any systemic therapy. At the same time, treatment is requested because of significant cosmetic and functional handicap. Intralesional triamcinolone acetonide (TA) in the proximal nail fold was evaluated as a treatment modality in 30 patients with twenty-nail dystrophy, 14 with nail lichen planus, and 6 with nail psoriasis. The number of involved nails varied from 1-20, and 1-10 nails were treated with TA. Fourteen patients discontinued treatment after 1-2 sittings. Out of the 28 patients completing the treatment protocol, 16 showed 75-100% improvement. Predominant side effects included pain, subungual hematoma formation, proximal nail fold hypopigmentation, and atrophy. TA given as a single injection in the proximal nail fold produced good improvement in a significant number of patients completing the treatment protocol. Lower concentrations of TA (5 mg/ml) were quite effective in treating various dermatoses affecting the nail unit. Our technique had fewer side effects than needle-less injection or multiple injection techniques. Careful attention to injection technique further minimized the side effects associated with the procedure. Sixteen patients completed the six-month follow-up and a relapse of nail changes was seen in 10. The relapses were equally responsive to retreatment. TA injected into the proximal nail fold area is a useful, cheap and efficacious treatment for dermatoses affecting the nail unit.

Trachyonychia and Twenty-Nail Dystrophy: A Comprehensive Review and Discussion of Diagnostic Accuracy

“…The once weekly nail plate dressings were found to improve symptoms after 3 months in a pediatric patient [37]. Intralesional triamcinolone improved symptoms in 17 of 25 reported cases [38,39,40]. This option, while appearing efficacious, is uncomfortable and may not be an appropriate selection for some pediatric patients.…”

“…Procedure-based options reported in the literature include nail plate dressings (ultra-thin adhesive bandage applied once a week with lactic acid, silicon dioxide, aluminum acetylacetonate, copolymer of vinyl acetate with acrylic acid, and azelaic acid) [37], intralesional injection of triamcinolone into the proximal nail fold [38,39,40], and topical psoralen UVA [41]. The once weekly nail plate dressings were found to improve symptoms after 3 months in a pediatric patient [37].…”

Trachyonychia: A comprehensive review

“…[44] Patient compliance with treatment continuation is poor secondary to pain. [1,44,50,51] For a 6-year-old boy, Sehgal et al reported the successful combination of intra-matrix steroids administered under general anesthesia with ketamine and oral griseofulvin (10 mg/kg administered in single or divided doses for six months). [45,46] The griseofulvin is believed to play an anti-inflammatory role in patients with trachyonychia associated with lichen planus and is best paired with intra-matrix steroids.…”

Role of nail biopsy as a diagnostic tool

“…However, it cannot be recommended for the routine evaluation of this otherwise benign disorder, especially because the further treatment options are generally not altered. [25] Nail psoriasis NB for nail psoriasis has been an area of interest, especially because 1-5% of the cases with psoriasis may present with purely nail manifestations only. [8] Hanno et al proposed diagnostic criteria of nail psoriasis in the form of presence of neutrophils in the nail bed epithelium (major criterion), hyperkeratosis with parakeratosis, serum exudates, focal hypergranulosis, and nail bed epithelium hyperplasia (minor criteria) [4] [ Figure 9].…”