ISSN:
1365-2230
Source:
Blackwell Publishing Journal Backfiles 1879-2005
Topics:
Medicine
Notes:
All clinicians will be familiar with the typical protective measures that can be combined with topical steroid treatments in inflammatory skin diseases affecting the nail. However, there are choices concerning the strength of the treatments, how they might be applied and for how long. In addition there are topical alternatives to steroids in some instances, such as calcipotriol and the oral nonsteroidal anti-inflammatory nimeluside, in hyperkeratotic pustular variants of psoriasis.In this presentation we will also cover the further alternative of injected steroid, detailing the technique, selection of the subject and pattern of injection according to different practitioners. This is of relevance mainly in nail psoriasis, but can also be helpful in hyperkeratotic eczema, lupus erythematosus and some manifestations of lichen planus.Nail lichen planus represents a particularly resistant category of nail disease and justification of potent systemic therapy may require nail biopsy to provide diagnostic certainty. Unlike in psoriasis, potent therapy may be justified in children as well as in adults and may take the form of local or systemic injected steroid as well as courses of oral steroids lasting for several months. In children there is a spectrum of nail disease where the rough nails of ‘20 nail dystrophy’ may be in the nondestructive category of a histologically eczematous process, or may be lichen planus. The latter is at risk of progression with scarring, especially in children of Asian origin.In addition to steroid in its various forms, there are other treatments for psoriasis and lichen planus that cover a range of mechanisms. These include 5-fluorouracil, dithranol, cyclosporin, methorexate and oral retinoids as well as forms of electromagnetic radiation such as PUVA16 and superficial X-ray. As a final resort, certain forms of dystrophy wholly resistant to medical therapy may necessitate nail avulsion and matrix ablation. This is mainly seen with upgrowing big toenails and pincer nail deformity.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1046/j.1365-2230.2002.10438.x
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