Intramatricial injections for nail psoriasis: An open-label comparative study of triamcinolone, methotrexate, and cyclosporine.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. LIMITATIONS: 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. CONCLUSIONS: 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.

Clinical and serological characteristics of nail psoriasis in Indian patients: A cross-sectional study.

BACKGROUND: Nail involvement in psoriasis is common with a lifetime incidence of 80-90%. It may reflect severity of cutaneous involvement and predict joint disease. Yet it remains, poorly studied and evaluated especially in Indian psoriatic patients. AIM: The present study was undertaken to evaluate clinical and serological profile of nail involvement in psoriasis and to assess quality of life impairment associated with nail involvement in Indian patients. METHODS: Consecutive patients with nail psoriasis were assessed for severity of cutaneous disease (psoriasis area severity index score) and nail disease (nail psoriasis severity index score). The impairment in quality of life attributable to nail disease was scored with nail psoriasis quality of life 10 score. All patients were also assessed for joint disease and tested for inflammatory and serological markers as erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor and anti-cyclic citrullinated peptide antibodies. RESULTS: In our cohort of 38 patients with nail psoriasis, 9 had concomitant psoriatic arthritis. The mean psoriasis area severity index was 14.4 ± 9.6 (range = 0.4-34). The most commonly recorded psoriatic nail changes were pitting (97.4%), onycholysis (94.7%) and subungual hyperkeratosis (89.5%). The mean nail psoriasis severity index score was 83.2 ± 40.1 (range = 5-156) and mean nail psoriasis quality of life 10 was 1.1 ± 0.4. Erythrocyte sedimentation rate and C-reactive protein were raised in 22/38 (57.9%) and 15/38 (39.5%) patients, respectively; rheumatoid factor was positive in 5/38 (13.2%) and anti-cyclic citrullinated peptide antibody was raised in 4/38 (10.5%) patients. LIMITATIONS: Small sample size and lack of a control group. CONCLUSIONS: In Indian patients with nail psoriasis, severity of nail involvement was found to be poorly correlated with the extent of cutaneous disease. In addition the impact of nail disease on patient's quality of life was found to be minimal. This suggests the need for a quality of life questionnaire suited to the Indian population. Serological markers were raised overall in the study patients and more so in the patients with concomitant arthritis.

Prevalencia de alteraciones ungueales en pacientes con Lepra en el instituto dermatólogico de Jalisco "DR. José Barba Rubio" / No disponible

La enfermedad de Hansen es una entidad infecciosa crónica, afecta principalmente piel y nervios periféricos. Algunos cambios ungueales tienen relación directa con afecciones secundarias a neuropatía y por ende a trauma, aunque también el déficit vascular y las infecciones son causa de las alteraciones ungueales. Se realizó un estudio transversal del 1 de septiembre al 31 de diciembre de 2013, incluyendo 24 pacientes con lepra, diagnosticados por los criterios: clínico, baciloscópico e histopatológico, mayores de 18 años. Se evaluaron el tipo y número de alteraciones ungueales de pies y manos, describiendo además las variables de género, edad, tiempo de evolución tipo de lepra y topografía. La prevalencia de las alteraciones ungueales en pacientes con lepra en el Instituto Dermatológico de Jalisco Dr. José Barba Rubio fue del 92%. Se encontraron 19 alteraciones, predominando el engrosamiento ungueal en 16/24 (67%), seguido de estrías longitudinales en 13/24 pacientes (54%). Es importante destacar que los pacientes con lepra lepromatosa presentaron más alteraciones ungueales y en estos las estrías longitudinales fue el cambio más observado

Hansen's disease is an infectious disease, which affects skin and peripheral nerves principally. Some nail changes have direct relationship with secondary neuropathy and therefore with trauma, even thaw vascular deficit and infections are also cause of nail dystrophy. A transversal study were make during September 1st to December 31st 2013, including 24 patients with diagnosis of leprosy according to clinical, baciloscapic and histopathology criteria in 18yo and older, hands and foot nail dystrophy were evaluated describing gender, age, time of evolution before diagnosis, leprosy pole, topography and number of nail dystrophies. Prevalence of nail dystrophies in leprosy patients at Instituto Dermatologico de Jalisco Dr. Jose Barba Rubio was 92%. We found 19 dystrophies, mostly nail thickening in 16/24 (67%), followed by longitudinal striations in 13/24 patients (54%). It's important to point that patients with lepromatosis leprosy had more nail dysptrophies and in these longitudinal striations were the most observed chage

Nail involvement in leprosy: a study of 300 patients.

Three hundred leprosy patients were recruited to study the pattern and frequency of nail changes. Nail changes, like longitudinal ridging in finger nails, transverse striations involving both finger and toe nails etc. which occurred with similar frequency in the PB and MB patients in comparison with the control group, were excluded from the analysis. Out of a total number of 150 PB patients, 84 (56%) showed nail changes. Fifty-eight (38.6%) patients showed changes in the finger nails, with an average of 3.2 involved nails per patient. Fifty-three (35.3%) patients showed changes in the toe nails, with an average of 3.0 nails per patient. The most common change observed was longitudinal melanonychia (32.4%) in the finger nails and longitudinal ridging (46.3%) in the toe nails.In comparison, 131/150 (87.3%) MB patients showed nail changes. Finger nail changes were seen in 102 (68%) patients with an average of 5.5 nails affected per patient. Changes in toe nails were seen in 116 (77.3%) patients, with an average of 6.0 nails involved per patient. The most common nail change observed was longitudinal melanonychia in 89/523, (17%) of the total involved finger nails and subungual hyperkeratosis in 164/702, (23.4%) of the total toe nails involvement. Out of a total of 32 colony patients, 31 (96.9%) showed nail changes both in finger and toe nails with an average of 7.9 and 8.4 affected nails per patient, respectively. The most common nail change observed was rudimentary nail(s) on fingers (29%) and toes (21.1%). Among MB patients, a significantly higher number had finger nail involvement in LL group. The frequency of nail involvement for both fingers and toes was significantly greater in LL as compared to BL group of patients. The frequency of nail involvement was significantly more in patients having disease for more than 5 years and in those having trophic changes secondary to loss of sensations and impaired circulation.