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- Title
Intramatricial injections for nail psoriasis: An open-label comparative study of triamcinolone, methotrexate, and cyclosporine.
- Authors
Mittal, Jyotisterna; Mahajan, Bharat Bhushan
- Abstract
<bold>Background: </bold>One of the most effective options available for treating psoriatic fingernails is intramatricial injection of triamcinolone acetonide. Efficacies of intramatricial methotrexate and cyclosporine have not been comparatively evaluated to date.<bold>Methods: </bold>Ninety fingernails in 17 patients were assigned to three groups of thirty nails each, and treated with intramatricial injections of triamcinolone acetonide (10 mg/ml), methotrexate (25 mg/ml) and cyclosporine (50 mg/ml) respectively. Each nail was given two injections with a 6-week interval, and graded at 24 weeks using the Nail Psoriasis Severity Index.<bold>Results: </bold>In both triamcinolone acetonide and methotrexate groups, 15 (50%) nails out of 30 showed >75% improvement. In the cyclosporine group, only ten (33%) nails showed >75% improvement. Side effects were most in the nails treated with cyclosporine.<bold>Limitations: </bold>The limited follow-up period of 24 weeks may have been insufficient for detecting delayed remissions. The number of patients was small and there was no randomization or blinding. The lack of a placebo/ no- treatment arm can be considered a limitation.<bold>Conclusions: </bold>Amongst the three drugs studied, intramatricial methotrexate injection yielded the most improvement with minimum side effects, results being comparable to intramatricial triamcinolone acetonide injection. Cyclosporine was the least effective drug, with the most side effects. Intramatricial injection therapy is a safe, economical, simple and effective therapeutic modality in the management of nail psoriasis.
- Subjects
DISEASE risk factors; PSORIASIS; TRIAMCINOLONE; METHOTREXATE; CYCLOSPORINE; THERAPEUTICS; DERMATOLOGIC agents; INJECTIONS; LONGITUDINAL method; NAIL diseases; DIAGNOSIS
- Publication
Indian Journal of Dermatology, Venereology & Leprology, 2018, Vol 84, Issue 4, p419
- ISSN
0378-6323
- Publication type
journal article
- DOI
10.4103/ijdvl.IJDVL_73_16