Azathioprine pulse therapy in the treatment of psoriasis nail: A case series

Abstract

Abstract Background Various treatments available for treating nail changes in psoriasis are able to clear the lesions but relapse is common. While treating psoriasis with azathioprine pulse therapy, it was observed that the lesion of nails including pitting, dystrophy, etc. was also cleared. Aim To check whether intermitted high dose (IHD) with continuous low dose azathioprine given to clear psoriasis could also clear the nail changes and produce prolonged remission. Methods 7 out of 60 psoriasis patients treated with azathioprine pulse therapy (APT) had psoriatic lesion on nails also. All the 60 patients received azathioprine pulse therapy for treating psoriasis, which contain azathioprine 500 mg given on 3 consecutive days and was repeated every month on the same date along with azathioprine100 mg orally in between the IHD. The entire treatment schedule was divided into four phases. Phase I continued till complete clearance of all lesions on the skin. In Phase II, 9 more APTs are given. In Phase III, only azathioprine 100 mg is continued for 9 months. In Phase IV, 100 mg was also stopped and patients were followed up without any treatment. Results Out of 7 patients, 5 had pitting of nails which cleared in 2–13 months. All the nails having pitting are in remission from 14 to 106 months. One patient had dystrophy of all nails of 2-yr duration, which cleared in 3 months. However, he developed relapse along with relapse of psoriasis after 26 months in remission, which subsequently cleared in 10 months on continuing APT and he is in remission since 62 months. White nails in 1 patient cleared in 17 months, and she/he is in remission since 17 months. Conclusion Azathioprine pulse therapy regimen is able to put psoriatic nail changes into prolonged remission.