Treatment with intralesional methotrexate injection in a patient with nail psoriasis

Yesim Akpinar Kara

doi:10.7241/ourd.20221.14

Abstract

Psoriasis vulgaris is an inflammatory skin disease involving the skin, nails, and joints. While nail involvement is observed in 70–80% of patients with psoriasis, the rate of patients with isolated nail involvement is 5–10%. Dystrophies arising in the nails in psoriasis affect the patient’s quality of life, and local and systemic therapies may be used as treatment. Intralesional methotrexate or corticosteroid injection might be an option in the treatment of patients with the involvement of one nail or some nails or without the involvement of the skin and joints, due to the side effects of systemic and biological agents. Herein, we report a female patient with nail psoriasis resistant to a previously applied topical treatment, the efficacy of intralesional methotrexate without the use of a systemic antipsoriatic agent, and no progression of side effects.

Highlights

Psoriasis is the most common skin disease affecting the nails
Leukonychia, erythema of the lunula, which are among the nail findings of psoriasis, progress depending on the nail plate thickening and the matrix crumbling; salmon patches, splinter hemorrhage, subungual hyperkeratosis, and onycholysis are seen in the involvement of the nail bed [2]
Nail psoriasis is known to be resistant to numerous treatment methods more than cutaneous psoriasis, including to potent biological agents

Summary

Introduction

Psoriasis is the most common skin disease affecting the nails. Nail changes may be associated with skin lesions while isolated nail psoriasis (1–5%) without skin involvement may appear [1]. Intralesional injections of steroids or methotrexate, systemic and biological agents, and laser therapy are among the available treatments for nail psoriasis. Several studies on intralesional MTX injection in nail involvement in psoriasis have been reported [4,5,6].

Results

Conclusion