Clobetasol for Nail Psoriasis

Title: Treatment of nail psoriasis with 8% clobetasol nail lacquer: positive experience in 10 patients.
: Sanchez Regana M, et al.
Publication: J Eur Acad Dermatol Venereol. 2005 Sep;19(5):573-7.

Treatment of nail psoriasis is difficult, as several topical therapies had poor results due to limited drug penetration through the nail. Recently, a new formulation of 8% clobetasol-17-propionate in a colorless nail lacquer solution has been shown to be beneficial in treating nail psoriasis.

The authors wanted to determine the efficacy and safety of 8% clobetasol-17-propionate drug in nail lacquer solution. To do this, they enrolled 10 patients with both nail bed and nail matrix (nail root) psoriasis. These patients were treated with the topical drug once daily for 21 days and then twice weekly for 9 months.

The authors reported that within 4 weeks of therapy there was reduction in all symptoms, including nail pain. Response to the therapy is directly related to the length of treatment – with longer treatment yielding best results. The authors reported that nail symptoms that responded well to therapy include:

  • Onycholysis or separation or loosening of the nail from its bed
  • Pitting of the nail
  • Salmon-colored patches on the nail
  • The following nail symptoms had moderate to poor improvements:
  • Subungual hyperkeratosis or formation of hard keratinous tissue under the nail
  • Splinter hemorrhages or small areas of bleeding under the fingernails

The authors noticed that the topical drug was well tolerated in all of the patients and there were no local (such as tissue death or atrophy, and infection) or systemic side effects. They concluded that a formulation containing 8% clobetasol-17-propionate is a safe, effective, and cosmetically acceptable treatment of nail bed and nail root psoriasis.

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