Lower triamcinolone acetonide injections equally as effective in nail psoriasis

Key takeaways:

• A 2.5 mg/mL dose of triamcinolone acetonide showed equally as efficacious treatment for nail psoriasis vs. higher doses.
• The lower dose was superior to a 5 mg/mL dose for nail bed psoriasis.

SAN DIEGO — A lower concentration of intralesional triamcinolone acetonide was as efficacious as higher concentrations for nail psoriasis.

“Intralesional triamcinolone acetonide (ILTAC) is first-line therapy for isolated nail psoriasis (NP) affecting [three or fewer] nails, but optimal concentration is unclear,” Jose W. Ricardo, MD, a clinical research fellow at Weill Cornell Medicine, and colleagues wrote in a poster presented at the American Academy of Dermatology Annual Meeting.

Researchers included 10 adult patients with isolated nail psoriasis affecting at least two digits in an intra-subject, randomized controlled study. A total of 73 fingernails were included.

Fingernails were randomly assigned to receive 2.5 mg/mL, 5 mg/mL, 7.5 mg/mL or 10 mg/mL of ILTAC, diluted with 1% lidocaine, or 0.9% saline via a 0.1 mL to 0.2 mL intramatricial injection at 5-to-7-week intervals for three treatment sessions.

All four treatment groups experienced improvements in mean nail psoriasis severity index (NAPSI), matrix (NAPSIm) and bed (NABSIb) scores from baseline (P < .05).

For nail bed psoriasis, the 2.5 mg/mL concentration was superior to the 5 mg/mL dose (P = .03) and placebo (P = .008).

The most common adverse event was cuticle retraction, which occurred in 0%, 6%, 18%, 38% and 43% of nails in the placebo, 2.5 mg/mL, 5 mg/mL, 7.5 mg/mL and 10 mg/mL groups, respectively.

“ILTAC 2.5 mg/mL is equally effective as higher concentrations in treating isolated NP, with lower rates of [adverse events],” the authors wrote. “Larger randomized controlled trials are necessary to corroborate whether 2.5 mg/mL ILTAC is optimal dosing for isolated NP involving [three or fewer] nails.”