Lee Julia Yu-Yun
Department of Dermatology, National Cheng Kung University, College of Medicine and University Hospital, Tainan, Taiwan.
Dermatol Online J. 2009 Nov 15;15(11):8.
Severe involvement of the nail matrix can lead to extensive dystrophic changes of the nail plate. Topical or intralesional corticosteroids, photochemotherapy, oral retinoids, and methotrexate (MTX) are among the therapies used. Treatment of severe psoriatic nail disease is often unsatisfactory. We report a case of severe psoriatic nail dystrophy involving all 20 nails successfully treated by low dose MTX. A previously healthy 11-year-old girl presented with painful deformity involving all 20 nails that developed over a one-month period. Examination revealed geographic and fissured tongue, as well as severe nail dystrophy of all 20 nails characterized by erythematous swelling of the nail folds, yellowish discoloration of nail plates with pitting, severe crumbling and destruction, transverse depressions, prominent oil spots, and swelling of proximal nail. Topical clobetasol propionate and calcipotriol were tried first but the nail dystrophy continued to progress. Low dose of MTX (5 mg per week) was initiated. The response was fairly satisfactory with emergence of normal plate proximally as early as 4 weeks; complete resolution of the severe nail dystrophy was achieved after 9 and 13 months of MTX therapy for fingers and toes, respectively. The present case illustrates that weekly low dose oral MTX may be a good treatment option for severe psoriatic nail dystrophy in patients without other contraindications for MTX therapy.
甲母质的严重受累可导致甲板广泛的营养不良性改变。局部或病灶内注射皮质类固醇、光化学疗法、口服维甲酸和甲氨蝶呤（MTX）都是常用的治疗方法。严重银屑病甲病的治疗往往不尽人意。我们报告一例累及所有20个指甲的严重银屑病甲营养不良病例，经低剂量MTX成功治疗。一名此前健康的11岁女孩出现累及所有20个指甲的疼痛性畸形，在1个月内逐渐发展。检查发现地图舌和沟纹舌，以及所有20个指甲的严重甲营养不良，表现为甲襞红斑肿胀、甲板发黄伴凹点、严重碎裂和破坏、横向凹陷、明显的油滴斑以及近端甲肿胀。首先尝试外用丙酸氯倍他索和卡泊三醇，但甲营养不良仍继续进展。开始使用低剂量MTX（每周5毫克）。反应相当令人满意，早在4周时近端就出现了正常甲板；分别在MTX治疗手指和脚趾9个月和13个月后，严重甲营养不良完全消退。本病例表明，对于无MTX治疗其他禁忌证的严重银屑病甲营养不良患者，每周低剂量口服MTX可能是一种很好 的治疗选择。
