Background
Nail lichen planus (NLP) impacts 10–15% of patients with lichen planus and is characterized by discomfort and the potential for permanent damage. Intralesional triamcinolone acetonide (TA) is a first-line treatment; however, comprehensive efficacy data is lacking.
Objective
To evaluate and compare changes in nail lichen planus severity using the Nail Lichen Planus Severity Index (NALSI) in affected fingernails and toenails treated with intramatricial TA (5 mg/ml) injections at 4-weekly and 8-weekly intervals, respectively.
Methods
A retrospective analysis was done for 17 NLP patients treated over 11 years with intramatricial TA (5 mg/ml). Photographic records from each visit were analysed to score disease severity using NALSI. Comparison was made of the percentage of fingernails versus toenails achieving NALSI-50 (50% reduction in NALSI over baseline) at the 3rd and 6th injections.
Results
These 17 patients had 232 nails (68.2%) affected by lichen planus, of which 130 (56%) were fingernails and 102 (44%) were toenails. The mean baseline NALSI of 7.4 ± 2.7 for fingernails, decreased to 6.6 ± 2.7 at the 3rd session, and 4.2 ± 3.2 at 6th session, while for toenails it dropped from 7.02 ± 2.6 to 6.6 ± 2.5 and 5.9 ± 3.0, respectively. By the treatment endpoint (4/8 weeks after fifth injection, respectively, for fingernails and toenails), NALSI-50 reduction was achieved in 40.7% fingernails and 10.8% toenails; while NALSI-75 reduction was achieved in 21.5% fingernails and 4.9% toenails, respectively. Throughout the course of the therapeutic intervention, the proportion of fingernails exhibiting irreversible alterations remained stable at 11.5%. However, a notable increase was observed for toenails, rising from 11.7% at baseline to 13.7% by the conclusion of the study. The adverse effects included pain (23.5% of patients), proximal nail-fold hyperpigmentation and atrophy (23.5%), and subungual hematoma (17.6%).
Conclusion
Intramatricial TA (5 mg/ml) injections are safe and effective in the treatment of NLP, with greater efficacy being noted in fingernails.
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