A Case of Nail Psoriasis Successfully Treated with Intralesional Methotrexate

Abstract

Psoriasis is a chronic inflammatory disease affecting the skin, nails, and joints. About 61% of psoriatic patients have nail involvement that can cause a significant social problem. Treating nail psoriasis is challenging but can improve the health outcomes and quality of life of patients. Treatment options available for nail psoriasis including topical therapy, intralesional injections, and systemic and biologic agents have various side effects and some benefits. Management is currently inconclusive. Intralesional injection of methotrexate in nail psoriasis was previously documented in few cases. We present a case of nail psoriasis successfully treated with low-dose intralesional methotrexate with no significant side effects in a 48-year-old psoriatic patient. Given the various side effects of conventional topical and systemic therapies limiting their use, we conclude that intralesional methotrexate injection seems to be a safe and effective treatment option for nail psoriasis. However, large controlled studies are needed.

Keywords: Intralesional methotrexate; Nail psoriasis; Treatment.

Fig. 1

a, b Nail dystrophy in a psoriatic patient with different degrees of subungual hyperkeratosis, pachyonychia, longitudinal striations, trachyonychia, filiform hemorrhage, plate crumbling, leukonychia, and onycholysis with brachyonychia. c, d Total healing 3 months after the last session of intralesional methotrexate

Fig. 2

Histological features of the nail bed biopsy (H & E, × 40): acanthosis, papillomatosis, and lymphocytic inflammatory infiltration