Treatment Of Nail Psoriasis Research Articles

Case report: Intralesional secukinumab injection for pediatric nail psoriasis: does it have to be a positive outcome?

Recent studies have shown that local injection of secukinumab can achieve positive therapeutic effects when applied in the treatment of nail psoriasis. At present, there have been no other studies on the use of biological agents in the treatment of pediatric nail psoriasis. Three children were included in the study to evaluate the efficacy and safety of periungual injection and long-term injection of secukinumab in the treatment of nail psoriasis in children. It was found that local injection did not achieve a remarkable therapeutic effect. The nail lesions were improved continuously by subcutaneous injection once a month.

Devices for treatment of nail psoriasis.

Nail psoriasis (NP) affects a significant proportion of cutaneous psoriasis patients, often leading to functional impairment and psychosocial distress. Despite available treatment options, challenges persist in achieving efficacy and with drug delivery, prompting investigation into novel therapeutic devices. A literature search was performed using the PubMed database for devices and lasers for NP on 17 October 2023 using the following search terms: device OR laser AND "nail psoriasis." Twenty-two articles were included describing treatment with pulsed dye laser, fractional carbon dioxide (CO<inf>2</inf>) laser, long-pulsed Nd:YAG laser, excimer laser, photodynamic therapy, intense pulsed light, and microneedling device. While some recent studies on use of therapeutic devices have shown promising results for NP treatment, current evidence supports an algorithmic approach including topical therapies, intralesional kenalog injections, and systemic therapies, depending on number of nails affected, presence of psoriatic arthritis, cutaneous psoriasis, comorbidities, and effect on quality of life. Laser therapy, although promising, requires further validation through extensive randomized trials before its inclusion in treatment regimens. These exploratory findings highlight emerging therapies that may expand the spectrum of options available. Use of lasers for NP treatment could provide dermatologists with a broader arsenal for customizing treatment plans that address individual patient needs, taking into account comfort, cost, and compliance to enhance overall patient outcomes.

Devices for treatment of nail psoriasis

IntroductionNail psoriasis (NP) affects a significant proportion of patients with cutaneous psoriasis patients, often leading to functional impairment and psychosocial distress. Despite available treatment options, challenges persist in achieving efficacy and with drug delivery, prompting investigation into novel therapeutic devices.Areas coveredA literature search was performed using the PubMed database for devices and lasers for NP on 17 October 2023 using the following search terms: device OR laser AND "nail psoriasis". Twenty-two articles were included describing treatment with pulsed dye laser, fractional CO₂ laser, long-pulsed Nd:YAG laser, excimer laser, photodynamic therapy, intense pulsed light, and microneedling device. Expert opinionWhile some recent studies on use therapeutic devices have shown promising results for NP treatment, current evidence supports an algorithmic approach including topical therapies, intralesional Kenalog injections, and systemic therapies depending on number of nails affected, presence of psoriatic arthritis, cutaneous psoriasis, comorbidities, and effect on quality of life. Laser therapy, although promising, requires further validation through extensive randomized trials before its inclusion in treatment regimens.These exploratory findings highlight emerging therapies that may expand the spectrum of options available. Use of lasers for NP treatment could provide dermatologists with a broader arsenal for customizing treatment plans that address individual patient needs, taking into account comfort, cost, and compliance to enhance overall patient outcomes.

Long-pulsed nd: YAG laser treatment of nail psoriasis: clinical and ultrasonographic assessment

Nail psoriasis is a chronic, inflammatory condition which is difficult to treat, linked with greater psoriasis severity, and may be associated with anxiety and significant functional impairment of the quality of life. The 1064 nm Nd: YAG laser was reported to yield satisfactory results in the treatment of nail psoriasis.The aim of the study was to assess the clinical and ultrasonographic efficacy of long-pulsed 1064 nm Nd: YAG laser in the treatment of fingernail psoriasis and compare its effect to control fingernails.This intra-patient randomized controlled trial analyzed 86 fingernails collected from 13 patients suffering from cutaneous and nail psoriasis. The nails were randomized into two groups. Group A was treated with Nd: YAG laser once monthly for three sessions while group B served as control. Assessment took place at baseline, 1 and 3 months after the last treatment session. For scoring, the 32-points target NAPSI scoring systems was used. Additionally, two blinded dermatologists’ score of improvement, patients’ pain assessment by visual analogue score and ultrasonographic assessment were all performed.At the end of follow up, the medians of tNAPSI score, plate definition, matrix thickness, bed thickness and bed vascularity decreased significantly in the Nd: YAG laser treated group in comparison to baseline (p = 0.001, 0.006, 0.039, < 0.001 and 0.010, respectively). While, there was a non-significant reduction in median tNAPSI score in the control group at last follow up, however, ultrasonography recorded a significant reduction in the medians of plate definition, bed thickness and vascularity (p = 0.002, 0.011 and 0.033, respectively) from the baseline. Comparison of the Nd: YAG laser and the control groups showed no significant difference from baseline regarding the medians of tNAPSI, tNAPSI percentile improvement, pits count, blinded evaluation of photographs and ultrasonographic assessments.In conclusion, Nd: YAG laser showed clinical and ultrasonographic improvement in fingernail psoriasis. Ultrasonography is a useful noninvasive tool in diagnosing and monitoring the clinical and even the subclinical changes in nail psoriasis. Nail psoriasis although difficult to treat, may show spontaneous improvement.

Efficacy of Intralesional Methotrexate Injection versus Triamcinolone Acetonide in Nail Psoriasis: A-Systematic Review and Meta-Analysis

Introducion: Psoriasis is a chronic inflammatory skin disease that can affect many parts of the body. Psoriatic involvement of the nail bed or nail matrix results in nail psoriasis that is common. Patients with psoriatic nails have impaired quality of life due to the appearance of nails, and significant morbidity and functional impairments may arise in large cases. The management of nail psoriasis is challenging because it is usually time-consuming with unsure outcomes. The existing evidences suggest that intralesional injection are particularly effective for nail psoriasis. Current studies provide recommendations on the intralesional injection technique, recommending an optimal concentration of methotrexate (MTX), triamcinolone acetonide (TA), and cyclosporine but the comparison of these treatment was still limited. Objective: This study aimed to evaluate the efficacy of intralesional injections of MTX compared with TA in treating nail psoriasis using Nail Psoriasis Severity Index (NAPSI) score. Methods: A systematic literature search was performed using EBSCOhost, Scopus, ProQuest, ScienceDirect, SpringerLink, Elsevier Clinical Key, Cochrane library, ClinicalTrials.gov subgroups terms: “intralesional methotrexate injections for nail psoriasis”, “intralesional triamcinolone acetonide injections for nail psoriasis” and “NAPSI Score”. Three studies were included in the qualitative synthesis and meta-analysis. Results: The overall SMD in NAPSI scores after administration of intralesional injection of MTX and TA was -0.213±0.232 (95% CI = -0.667 to 0.241). The Q statistic value was -0.921 (p=0.357), indicating the insignificant difference in the effectiveness of both therapies. Conclusion: Both MTX and TA were effective in treating nail psoriasis based on the reduction of NAPSI score.

Intense pulsed light versus pulsed dye laser in the treatment of nail psoriasis: Intra-patient left to right comparative controlled study.

Background Until now, the management of psoriatic nails has not been satisfactory. Pulsed dye laser (PDL) as well as intense pulsed light (IPL) have been evaluated separately for the management of psoriatic nails and proved to be effective. Aim This study aimed to measure and compare the usefulness as well as the safety of intense pulsed light versus pulsed dye laser for the management of psoriatic nails. Methods The psoriatic fingernails of 20 patients were managed using intense pulsed light on one hand and pulsed dye laser on the other. Two to three psoriatic nails were left without treatment as controls. The therapeutic sessions were conducted monthly for a period of 6 months. Evaluation of the clinical outcomes was assessed by a blinded dermatologist depending on the total, nail bed, nail matrix, modified and target NAPSI scores. Patient global assessment, in addition to Nail Psoriasis Quality of Life (NPQL10), was performed to assess the response to the therapy. Results A significant reduction in the total, target and modified NAPSI scores from baseline to the end of the study was detected, but no significant differences were detected between the two treatments. The responses of the nail matrix and bed lesions to both modalities were nearly the same. All patients stated that the two devices were efficient and improved their quality of life. The intense pulsed light treatment was more painful. Complete clearance of nail lesions was not obtained. Limitations Lack of long-term follow-up of cases and preset laser parameters were the major limitations of this study. Conclusion Intense pulsed light, like pulsed dye laser, is safe and efficient in treating nail psoriasis; however, the former is more painful. Dermoscopy had an additive function in analysing the response of nail psoriasis to therapy.

Trial of Topical Tacrolimus by Two Different Concentrations in Treatment of Nail Psoriasis: Randomized Comparative Study

Trial of Topical Tacrolimus by Two Different Concentrations in Treatment of Nail Psoriasis: Randomized Comparative Study

Rapid response of nail psoriasis to secukinumab in patients with moderate to severe psoriasis after 12 weeks of treatment with a total of 24 weeks of follow-up.

Nail psoriasis, a subtype of psoriasis, can cause significant pain, disability, and reduced quality of life. Despite the established efficacy of anti-IL17 secukinumab in improving skin psoriasis, there is a lack of clinical trials focusing on nail psoriasis as primary endpoint. This study aims to investigate the efficacy of secukinumab in treating nail psoriasis in patients with moderate to severe psoriasis. We prospectively recruited patients newly diagnosed with moderate to severe psoriasis in single centre from January 2021 to January 2022 who were treated with secukinumab. A total of 16 patients consisting of 9 males and 7 females were included. Their mean age was 38.88 ± 10.29 years. They had an average initial Nail Psoriasis Severity Index (NAPSI) score of 45.06 ± 20.39 and an average NAPSI score at 12 weeks of 8.94 ± 13.50, showing a significant (p < 0.05) decrease of NAPSI score after 12 weeks of secukinumab treatment. After 24 weeks of treatment, NAPSI score was decreased to 5.12 ± 8.52. Secukinumab rapidly improved nail psoriasis after 12 weeks of treatment, with further enhancement at 24 weeks, suggesting its potential as a potent therapeutic option for nail psoriasis.

Assessing Comparative Efficacy of Biologics for the Treatment of Psoriasis With Nail Involvement: A Systematic Review.

Despite recent advances in biologics, there is a lack of significant evidence regarding the comparative efficacy of biologics in treating more resistant features of psoriasis, namely nail psoriasis. A systematic review synthesizing data from multiple studies is efficacious in assessing the comparative efficacy among biologics for the treatment of nail psoriasis. To evaluate and compare the efficacy of biologics for the treatment of nail psoriasis. Utilizing PRISMA guidelines, a systematic literature review was conducted using the Pubmed database on November 16, 2022. Studies selected were phase 3 or 4 randomized clinical trials, clinical studies, or other randomized trials with data on the treatment with biologics for adults with nail psoriasis. Sixteen studies meeting inclusion criteria were included for analysis. At 24weeks, the highest mean NAPSI percent improvement achieved at week 24 was by brodalumab (76.9%) followed by etanercept (74%) and ixekizumab (70.5%) while the biologics achieving the greatest proportion of NAPSI 0 were adalimumab (44.6%) and ixekizumab (41%). This study helps elucidate the comparative efficacy of biologics for the treatment of nail psoriasis. This review suggests that brodalumab and etanercept are associated with the highest percent improvement in nail psoriasis while adalimumab and ixekizumab are associated with the greatest probability of complete nail resolution.

43878 Bimekizumab versus secukinumab for the treatment of nail psoriasis in patients with moderate to severe plaque psoriasis: Results from the BE RADIANT phase 3b trial

43878 Bimekizumab versus secukinumab for the treatment of nail psoriasis in patients with moderate to severe plaque psoriasis: Results from the BE RADIANT phase 3b trial

The efficiency of the combination of topical and biological therapy in the treatment of nails psoriasis: a prospective study

Introduction. The severity of the psoriatic process is associated with the involvement of the scalp, genitals, fold zones and nails in the process. The selection of effective therapy for psoriasis of difficult localizations is an urgent task of modern dermatology.Aim. To evaluate the effectiveness of treatment of moderate psoriasis and nail psoriasis with an IL-17A inhibitor in combination with a combined betamethasone dipropionate + salicylic acid ointment.Material and methods. A 12-week prospective study included data from 60 patients who were under observation at the Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology in 2020-2021. Group 1 included 30 patients who received only the biological drug IL-17 inhibitor. Group 2 included 30 patients who received an IL-17 inhibitor in combination with topical therapy with an ointment of 0.05% betamethasone dipropionate and 3% salicylic acid (Rederm). The ointment was applied twice a day in two courses of 3 weeks with a break of 6 weeks between courses. When comparing indicators between groups, Student’s t-test was used for normal samples and the Mann- Whitney test for non- Gaussian samples.Results. When comparing PASI and NAPSI in patients of group 2 who received an IL-17 inhibitor in combination with external therapy with an ointment of 0.05% betamethasone dipropionate and 3% salicylic acid 2 times a day for two courses of 3 weeks with a break of 6 weeks between courses, the index values statistically significantly decreased after 12 weeks of therapy (p = 0.003) compared to group 1 (p = 0.015).Conclusions. The study showed that patients who received an IL-17 inhibitor in combination with a combined betamethasone dipropionate + salicycylic acid ointment achieved a significantly greater effect compared to patients who received only biologics. In addition, the combination with Rederm ointment has shown greater efficacy in the treatment of psoriatic onychodystrophy, which is difficult to treat even with biologics.

A Comprehensive Review of Ixekizumab Efficacy in Nail Psoriasis from Clinical Trials for Moderate-to-Severe Psoriasis and Psoriatic Arthritis.

Nail psoriasis is a difficult-to-treat manifestation of psoriatic disease affecting up to 80% of patients with psoriatic arthritis (PsA) and 40-60% of patients with plaque psoriasis (PsO). Ixekizumab (IXE), a high-affinity monoclonal antibody that selectively targets interleukin-17A, is approved for the treatment of patients with PsA and patients with moderate-to-severe PsO. This narrative review aims to summarize nail psoriasis data generated from IXE clinical trials in patients with PsA (SPIRIT-P1, SPIRIT-P2, and SPIRIT-H2H) and/or moderate-to-severe PsO (UNCOVER-1, -2, -3, IXORA-R, IXORA-S, and IXORA-PEDS) with an emphasis on head-to-head clinical trial data. Across numerous trials explored, IXE treatment was associated with greater improvement in resolution of nail disease versus comparators at week 24, results which were maintained up to and beyond week 52. Additionally, patients experienced higher rates of resolution of nail disease versus comparators at week 24 and maintained high levels of resolution up to week 52 and beyond. In both PsA and PsO, IXE demonstrated efficacy in treating nail psoriasis, and therefore may be an effective therapy option. Trial Registration: ClinicalTrials.gov identifier UNCOVER-1 (NCT01474512), UNCOVER-2 (NCT01597245), UNCOVER-3 (NCT01646177), IXORA-PEDS (NCT03073200), IXORA-S (NCT02561806), IXORA-R (NCT03573323), SPIRIT-P1 (NCT01695239), SPIRIT-P2 (NCT02349295), SPIRIT-H2H (NCT03151551).

Nail Psoriasis: An Updated Review of Currently Available Systemic Treatments.

Nail psoriasis (NP) has a prevalence that ranges from 10 to 82% among patients with psoriasis (PsO) and is one of the most common difficult to treat site of psoriasis. We performed a thorough review of the literature, exploring evidence regarding all available NP systemic treatments, describing also in detail NP dedicated clinical trials. A literature search was conducted in PubMed and Embase prior to February 2023 using a combination of the terms "nail" AND "psoriasis" AND "systemic therapy" AND/OR "systemic treatment". A total of 47 original studies and case reports were reviewed in this article. Systemic therapies should be considered when the disorder involves more than 3 nails, has extensive skin and joint involvement, and has a significant impact on QoL, due to their best long-term efficacy. In detail, conventional and biologic systemic drugs demonstrated efficacy in recent trials, including acitretin, methotrexate, cyclosporine, apremilast, adalimumab, infliximab, etanercept, certolizumab, golimumab, ustekinumab, secukinumab, ixekizumab, brodalumab, bimekizumab, guselkumab, risankizumab and tildrakizumab. Several therapies have demonstrated efficacy and safety in the treatment of NP; however, the choice of treatment depends not only on the severity of the nail involvement, but also on whether PsA is present, the patient's comorbidities other than PsA, previous treatment history, and the patient's drug preferences.

Fractional CO 2 Laser versus Fractional CO 2 Laser Plus Betamethasone/Calcipotriol Ointment in the Treatment of Nail Psoriasis.

Nail psoriasis has a major negative impact on the physical and psychological aspects of the patient's life. Treatment is often unsatisfactory because of the difficult penetration of the drug into the nail. To compare the efficacy of fractional CO 2 laser monotherapy versus combined fractional CO 2 laser and calcipotriol/betamethasone ointment preparation in treatment of nail psoriasis. Thirty patients with nail psoriasis with at least 2 affected fingernails were recruited for this study. Target NAPSI (tNAPSI) score was calculated at the start of the study and at 3 months after the last laser session. One affected fingernail of each patient received 6 sessions of fractional CO 2 laser with 4-week intervals. Another affected fingernail of each patient received topical betamethasone/calcipotriol ointment once daily in addition to the 6 fractional CO 2 laser sessions. In the monotherapy group, there was significant improvement in the nail matrix score, nail bed score, and tNAPSI score. In the combined therapy group, there was significant improvement in nail bed score and tNAPSI score, but nail matrix score showed no statistically significant improvement. Overall, there was no statistically significant difference between the 2 studied groups. Fractional CO 2 laser can be an effective and promising new treatment for nail psoriasis.

Comparison between the efficacy of Intense Pulsed Light (I.P.L.) versus Photo-Dynamic Therapy (P.D.T.) with methylene-blue in the treatment of psoriatic nails.

Nail affection is seen in up to 50 % of patients with skin psoriasis, although up to 5% of nail psoriatic patients do not complain of skin affection. Various treatment options are emerging for nail psoriasis such as intense pulsed light Tawfik, 2014). Methylene-blue (M.B) is a phenothiazine dye which is suggested to mediate cell cyto-toxicity by the generation of hydroxyl-radicals which change the intra-cellular calcium homeo-static mechanisms (Lee and Wurster, 1995). Evaluation and comparing the efficacy of I.P.L. and methylene-blue assisted photo-dynamic therapy for treating psoriatic nails. 20 patients with mild to moderate psoriasis with nail involvement. Sessions were performed once every 2 weeks on all the affected nails for a maximum of 3 months (6 sessions). Nail Psoriasis Severity Index (N.A.P.S.I.) score and photo-documentation were done for all the patients to assess the nail status at the first visit, after two, six sessions and three months after finishing the six session (0 m., 1 m., 3 m. and 6 m.). Nails of the right hand were treated with methylene-blue mediated photo-dynamic therapy using the Intense Pulsed Light (IPL) as the light source, while the left hand received conventional IPL (430-1200 nm) alone. The present study showed that both treatments were effective on nail psoriasis, but MB-PDT was more effective in nail-bed lesions. There was no significant difference regarding patient satisfaction. Both Intense Pulsed Light and methylene-blue assisted photo-dynamic therapy were safe, nearly pain-free, easy to use, and effective for treating nail psoriasis. MB-PDT is a new promising strategy for the treatment of nail psoriasis.

Fractional CO2 laser in the treatment of nail psoriasis: how can it help?

Treating nail psoriasis is often a time-consuming challenge with an unsecure outcome. Response to the treatment is variable and relapses are common. Systemic treatments have multiple systemic side effects and lack of the patient compliance makes intra-lesional therapies not the best choice for treatment of nail psoriasis. We aimed to evaluate and compare the efficacy and side effects of methotrexate versus calcipotriol plus betamethasone two-compound formula when applied topically to psoriatic nails after fractional CO2 laser. This comparative pilot study included 20 patients with nail psoriasis. One side was treated with fractional CO2 laser followed by the application of topical methotrexate (Group A) and the other side with fractional CO2 laser followed by topical (Calcipotriol 0.05 mg/gm + Betamethasone 0.5 mg/gm) (Group B). 4 sessions were done, once every 2 weeks. There was a high statistical significant decrease in total NAPSI score in group A at 1(P = 0.000) and 2 months (P = 0.000). There was a high statistical significant decrease in total NAPSI score in group B at 1(P = 0.001) and 2 months (P = 0.001). There was no statistical significant difference regarding total NAPSI score between both group A and B at 0 (P = 0.271), 1(P = 0.513) and 2 months (P = 0.647). Combined fractional CO2 laser with either topical MTX or topical betamethasone plus calcipotriol two-compound formula is effective treatment for nail psoriasis.

Topical cyclosporine hydrogel preparation: A new therapeutic option in the treatment of nail psoriasis.

Nail psoriasis is a chronic nail disorder that commonly affects psoriatic patients causing severe distress despite the limited body surface area. Treatments for nail psoriasis are limited, as nails are often difficult to treat with topical therapies, and among different systemic agents responses are unpredictable. We carried out a prospective study in order to analyze the effectiveness and tolerability of topical cyclosporine hydrogel ointment in nail psoriasis. Three patients, for a total of 44 nails, were treated with topical cyclosporine hydrogel ointment. All nails were evaluated, before starting the treatment, every 28 days and after 12 weeks of therapy, by the same dermatologists, through clinical and onychoscopic evaluations. The patients were also asked to assess on the compliance with product use. Complete response (CR) was observed in 2 of 3 patients; a partial response (PR) was observed in the other patient. Overall, 24 of 44 nails had CR and 20 had a PR. Cyclosporine hydrogel ointment has shown efficacy and safety in the treatment of nail psoriasis. The product has also been shown to be stable in composition, easy to apply and not discomfortable for the patient.

Netakimab in the therapy of psoriatic onychodystrophy

Psoriatic onychodystrophy affects up to 50% of patients with psoriasis and up to 80% of patients with psoriatic arthritis, with an estimated lifetime risk of nail plate changes in this patient population of up to 90%. Nail psoriasis is characterised by a variety of morphological changes resulting from the inflammation in the nail matrix or nail bed, leading to functional impairment and negative impact on patient’s quality of life. Psoriatic onychodystrophy is a distinct therapeutic problem, as its localization is torpid to the current treatment. The limited penetration of topical agents through the nail plate together with the poor adherence to treatment make them typically ineffective. Systemic therapy is often regarded by dermatologists as inappropriate for patients with limited cutaneous lesions. Many systemic drugs, especially biologics, are effective in treating nail psoriasis, but with delayed and less pronounced effects compared to the improvement of skin manifestations. Efficacy for nail changes should be evaluated after 3–6 months of therapy. Recent studies demonstrate that the best effect is achieved after 1 year of treatment. This article presents the main clinical features of psoriatic onychodystrophy and provides information about the interleukin 17A (IL-17A) inhibitor drug netakimab as a promising therapeutic agent for patients with nail psoriasis. It also describes our own clinical experience of using netakimab in the therapy of patients with psoriasis coupled with onychodystrophy. Our experience of using netakimab in two cases of resistant psoriasis accompanied by nail lesions demonstrates its high efficacy in treatment of patients with both plaque psoriasis and psoriasis with “difficult”, hard-to-treat locations, such as nail plate lesions.

Topical calcipotriol combined with urea 20% versus intralesional injection of triamcinolone acetonide, 5-fluorouracil, and methotrexate in the treatment of nail psoriasis: A comparative study.

There is no consistently effective treatment for psoriatic nails. Topical and intralesional modalities have been recently investigated and showed promising efficacy and safety. To compare the efficacy and safety of intralesional injection of 5-fluorouracil (5-FU), methotrexate (MTX), triamcinolone acetonide (TA) versus topical calcipotriol plus urea 20% in the treatment of nail psoriasis. This study included 60 patients with nail psoriasis who were randomly assigned to 4 groups, each containing 15 patients. The first 3 groups received intralesional injection of 0.1 ml of 5-FU (group A), MTX (group B), and TA (group C) into the nail matrix and bed monthly for 3 months. Group D received a topical combination of calcipotriol/urea 20% twice daily for 3 months. Therapeutic response was assessed every month for 3 months using the target nail psoriasis severity index (NAPSI). The mean percentage of improvement was significantly higher in topical calcipotriol/urea combination (57.1 ± 26.4) than intralesional TA (44.2 ± 32.7), intralesional MTX (37.7 ± 14.2), and intralesional 5-FU (29.6 ± 14). Adverse effects were mild and insignificant in the studied groups. Topical calcipotriol/urea combination seems to be more effective and safe than intralesional injections of 5-FU, MTX, and TA.

Comparison of fractional laser-assisted drug delivery and intralesional injection of triamcinolone acetonide in nail psoriasis.

The treatment of nail psoriasis is often unsatisfactory due to poor penetration of topical therapeutics through the nail plate. The development of innovative methods that provide adequate delivery of the drug into the nail is warranted. In this study, we aim to compare the efficacy of intralesional corticosteroid injection versus its topical application after fractional CO2 laser in the treatment of fingernail psoriasis. The study included 36 patients with fingernail psoriasis divided into two groups. The nails in group A were treated with intralesional injection of triamcinolone acetonide while the nails in group B received fractional CO2 laser therapy followed by topical application of the drug for six sessions. The evaluation was performed using NAPSI and dermatoscopic scores. Both modalities yielded a significant improvement of the nail matrix and bed psoriatic signs. No statistically significant difference was found between the two groups by both clinical and dermatoscopic assessment. The laser treatment was associated with significantly lower pain scores (P=0.03) and higher patient satisfaction (P=0.007). Fractional CO2 laser-assisted delivery of topical corticosteroids can be a potentially effective and well-tolerated therapeutic modality in the treatment of nail psoriasis with comparable efficacy to intralesional injection.