Grover C, Daulatabad D, Singal A
Department of Dermatology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.
Clin Exp Dermatol. 2017 Jun;42(4):420-423. doi: 10.1111/ced.13087. Epub 2017 Apr 10.
Nail psoriasis can be a debilitating condition; however, in patients with isolated nail involvement, the use of toxic systemic therapies such as methotrexate may not be justified. We report on 4 patients (30 involved nails between them), who were treated with injections of methotrexate (0.1 mL of a 25 mg/mL solution) into the nail bed at 3-weekly intervals. Mean baseline Nail Psoriasis Severity Index (NAPSI) was 4.77 (range 2-8, cumulative score 143; n = 30); dropping successively at each visit to 2.43 (range 0-4, cumulative score 73; n = 30) at 15 weeks. The decline in mean NAPSI from 4.87 to 2.17 was statistically significant (P < 0.001; Friedman analysis). Reported adverse effects were pain, injection site pigmentation and nail bed haemorrhage. Administration of specific targeted therapy to the nail bed may help manage nail psoriasis effectively.
甲银屑病可能是一种使人衰弱的病症；然而，对于仅累及指甲的患者，使用诸如甲氨蝶呤等毒性全身性疗法可能并不合理。我们报告了4例患者（他们共有30个受累指甲），这些患者接受了每隔3周向甲床注射甲氨蝶呤（25mg/mL溶液0.1mL）的治疗。平均基线甲银屑病严重程度指数（NAPSI）为4.77（范围2 - 8，累积评分143；n = 30）；在每次就诊时依次下降，至15周时降至2.43（范围0 - 4，累积评分73；n = 30）。平均NAPSI从4.87降至2.17具有统计学意义（P < 0.001；Friedman分析）。报告的不良反应有疼痛、注射部位色素沉着和甲床出血。向甲床给予特异性靶向治疗可能有助于有效治疗甲银屑病。
