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Intralesional injection of corticosteroid for severe nail psoriasis

Nail psoriasis is common in psoriatic patients, particularly in patients with joint involvement. Corticosteroid matrix injection with needle is a conventional treatment but pain is often a limitation. Clinical efficacy was evaluated according to Nail Psoriasis Severity Index (NAPSI) score of target nail differences before and after the treatment. Psoriasis is a common, chronic, inflammatory disease that has skin, nail, and systemic manifestations. The main drawback of intralesional corticosteroid injection is that it can be very painful, and the procedure is generally not very well tolerated.

Intralesional injection of corticosteroid for severe nail psoriasis 2Psoriatic nail disease can be difficult to treat and severe nail changes can severely affect quality of life. Intralesional injections, either with corticosteroids, methotrexate or ciclosporin, have proven beneficial. Psoriasis affects both nail matrix and nail bed. NAPSI (Nail Psoriasis Severity Index) score of Psoriatic nails after treatment with intralesional 0. Its severity may or may not reflect the severity of the skin or joint psoriasis. Intralesional triamcinolone acetonide injections into proximal nail folds.

Psoriatic nails are one of the most difficult management problems faced by dermatologists. Fingernails usually grow at a rate of 3 mm per month; therefore, topical therapy has to be continued for several months in order to achieve maximum benefit. Intralesional steroid injection with triamcinolone acetonide is useful for nail psoriasis. Figure 9: Technique of intramatricial corticosteroid injection. Most recent studies on nail psoriasis use the Nail Psoriasis Severity Index (NAPSI), target NAPSI, or one of its many variants as a marker of nail improvement 23. The existing evidence suggests that intralesional injection into the nail bed and matrix are particularly effective for alleviating lesions caused by psoriasis of the nail matrix, and also has moderate effects on nail bed signs (Table 1). Comparison of trials of steroid injections for nail psoriasis.

Psoriatic Nail Disease. Free Professional Reference

Intralesional injection of corticosteroid for severe nail psoriasis 3Psoriatic nails is a nail disease. It is common in those suffering from psoriasis, with reported incidences varying from 10 to 78. The Nail Psoriasis Severity Index (NAPSI) is a numeric, reproducible, objective, simple tool for evaluation of nail psoriasis. The joints (psoriatic arthritis), nails and scalp may also be affected. Severe, intense, generalized erythema and scaling covering entire body; Psoriatic plaques that fail to respond to topical therapy may be improved by administration of intralesional corticosteroid injections. Effective treatment of severe nail psoriasis using topical calcipotriol with betamethasone dipropionate gel Eugene Sern-Ting Tan, Hazel Hwee-Boon Oon National Skin Centre, Singapore Date of Web Publication6-Apr-2016. Currently, the most widely used topical agents for the treatment of nail psoriasis are corticosteroids and vitamin D3 analogs while intralesional injection of corticosteroids may be considered for patients with limited nail psoriasis. Symptoms are usually minimal, but mild to severe itching may occur. Treatment can include emollients, vitamin D analogs, topical retinoids, tar, anthralin, corticosteroids, phototherapy, and, when severe, methotrexate, oral retinoids, immunomodulatory agents (biologics), or immunosuppressants. For brave or stoic patients, possibly intralesional injection with corticosteroids. Psoriasis is a common inflammatory disorder affecting the skin that has a genetic component and several triggers (eg, trauma, infection, certain drugs). The severity of nail psoriasis depends largely on the nail part affected by the inflammatory reaction. Corticosteroids and vitamin D3 analogues are the first choice of treatment for nail bed psoriasis. Intralesional therapy is the injection of small doses of the drug directly into or near the specific structure of the nail unit: nail bed or nail matrix.

Management Of Psoriatic Nails