Botulinum toxin injection shows promise in nail psoriasis: A comparative randomized controlled trial

JAAD International Pub Date : 2024-04-30 DOI:10.1016/j.jdin.2024.03.021

Premjit Juntongjin MD, Suthima Srisinlapakig MD, MSc, Sunatra Nitayavardhana MD

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Abstract

Background

Nail psoriasis remains a challenging condition with limited satisfaction from current treatments. An increasing number of neuropeptides were reported in psoriatic tissue.

Objective

To compare the efficacy of botulinum toxin A (BoNT-A) injection, triamcinolone acetonide (TA) injection, topical combination of vitamin D/steroid (VitD/steroid) and placebo in improving nail psoriasis.

Methods

A 24-week randomized intraindividual comparative-controlled study involved participants with at least 4 psoriatic fingernails, each with a total target nail psoriasis severity index (NAPSI) score of at least 3 points. Nails were randomly received different treatments; intralesional BoNT-A injection at baseline, intralesional TA at baseline and eighth week, daily topical VitD/steroid application for 16 weeks and placebo.

Results

Evaluation of 64 psoriatic fingernails showed a 40% reduction in the total target NAPSI score at 24 weeks following BoNT-A injection (P = .001). BoNT-A significantly improved nail bed lesions more than TA and topical VitD/steroid (P = .038), with no reported serious adverse effects.

Limitations

Relatively small sample size; hand hygiene during the COVID-19 pandemic may interfere NAPSI score evaluation.

Conclusions

BoNT-A injection emerges as a promising and effective therapy for nail psoriasis, providing sustained efficacy lasting up to 6 months with a single injection.

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肉毒杆菌毒素注射有望治疗甲银屑病：随机对照比较试验

背景指甲银屑病仍然是一种具有挑战性的疾病，目前的治疗方法难以令人满意。目的比较肉毒毒素 A（BoNT-A）注射、曲安奈德（TA）注射、维生素 D/类固醇（VitD/类固醇）外用组合和安慰剂在改善指甲银屑病方面的疗效。方法一项为期 24 周的随机个体内比较对照研究涉及至少有 4 个指甲银屑病患者，每个患者的目标指甲银屑病严重程度指数（NAPSI）总分至少为 3 分。指甲随机接受了不同的治疗方法：基线注射 BoNT-A、基线和第八周注射 TA、16 周内每天外用 VitD/类固醇激素和安慰剂。结果对 64 例银屑病指甲的评估显示，注射 BoNT-A 后 24 周，目标 NAPSI 总分降低了 40%（P = .001）。BoNT-A对甲床病变的改善明显优于TA和外用VitD/类固醇（P = .038），且无严重不良反应。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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