Alitretinoin can be a good treatment option for idiopathic recalcitrant trachyonychia in adults: an open‐label study

Shin, Kyung-Min; Kim, T.-W.; Park, S.-M.; Lee, H.-J.; Jin, Hyun Seung; You, Hong; Shim, Woo‐Haing; Kim, G.-W.; Kim, H.-S.; Ko, Hyun Chang; Kim, B.-S.; Kim, M.-B.

doi:10.1111/jdv.15024

Cited by 6 publications

(6 citation statements)

References 22 publications

(43 reference statements)

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“…The second publication was a case series that discussed the usage of alitretinoin (first-generation retinoid) 30 mg daily for at least three months in the management of idiopathic recurrent trachyonychia in 21 patients. This study reported some improvement in 98.1% of 210 nails and complete improvement in 22.9% of 210 nails after three months of alitretinoin treatment [14]. Lastly, acitretin 0.4 mg/kg (25 mg) in combination with topical clobetasol 8% was successfully used to manage idiopathic trachyonychia with nail resolution after roughly one year [15].…”

Section: Discussionmentioning

confidence: 72%

“…Paradoxical to our case, retinoids have been described as possible treatment options for patients with idiopathic recurrent trachyonychia and occupational trachyonychia in several studies [13][14][15]. The first was a case report of a patient with a past history of psoriasis who worked as a jeweler and subsequently developed occupational trachyonychia secondary to a microtrauma; this was successfully treated with 0.3 mg/kg of acitretin daily [13].…”

Section: Discussionmentioning

confidence: 74%

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Trachyonychia Secondary to Acitretin Usage

Thieman

Clarey

Johnson

et al. 2020

Cureus

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Trachyonychia is a disease of the nail matrix that most commonly presents with sandpaper-like roughness of the nails. Retinoids are known to cause several nail abnormalities, likely due to their anti-proliferative effects. Despite this, no cases have been previously reported on the association of acitretin (second-generation retinoid) with trachyonychia. We present a single case of trachyonychia associated with acitretin that subsided following medication cessation.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 74%

Trachyonychia Secondary to Acitretin Usage

Thieman

Clarey

Johnson

et al. 2020

Cureus

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“…In addition, oral alitretinoin was found beneficial in treating isolated recalcitrant trachyonychia, achieving complete treatment response in 50% (6 of 12 patients) within 6 months of treatment. [ 11 ]…”

Section: Discussionmentioning

confidence: 99%

“…Recently, alitretinoin was reported beneficial in idiopathic recalcitrant trachyonychia. [ 11 ] Currently, treatment efficacy data are derived from non-comparative small case series and case reports.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Fluocinonide\Bifonazole Cream for the Treatment of Trachyonychia

Shemer

Daniel

Kassem

et al. 2022

Indian Journal of Dermatology

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Background: Trachyonychia is a benign nail condition, most commonly seen in children. Trachyonychia manifests as excessive longitudinal ridging, nail roughness, and nail brittleness. Treatment is sought mainly for esthetic reasons as well as functional reasons. A number of therapeutic approaches exist, mainly based on case reports or small non-comparative case series. Aims: To report treatment outcome among patients with trachyonychia. Methods: A retrospective case-series study was conducted among patients who were treated trachyonychia between years 2017 and 2020. Patients were prescribed fluocinonide 0.05% with bifonazole 1% cream, applied with or without occlusion, and methylprednisolone 1–2 mg/nail, injected into the involved nail matrix, or oral cyclosporine 3 mg/kg. Complete response (over 90% improvement) and partial response (over 50% improvement) were assessed. Results: A total of 43 patients with trachyonychia were included [mean age 10.0 years (±5.7), 69.8% males, mean disease duration 4.7 years (±3.0)]. In 90.7% of the cases, topical fluocinonide\bifonazole cream was prescribed. Under-occlusion topical application was found to be highly effective, achieving complete response in 35.3% and partial response in an additional 52.9% of the patients. Occluded application was also found to be significantly more effective than non-occluded application. Treatment efficacy was not affected by the severity of nail roughness, trachyonychia morphology, or whether trachyonychia was idiopathic or coexisted with other dermatological conditions. Conclusion: Occluded application of fluocinonide plus bifonazole cream is efficient for the treatment of trachyonychia and should be considered a first line of treatment.

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“…Topical agents include topical steroids, calcineurin inhibitors, and calcipotriol/betamethasone dipropionate ointments 13 . If there is no improvement after 3 months of topical treatment, intralesional steroid injection 14 or systemic medications such as systemic steroids, cyclosporine, and alitretinoin can be considered 12,15,16 . However, as there is insufficient data regarding the management, further studies are warranted to establish an ideal management strategy.…”

Section: Discussionmentioning

confidence: 99%

Histopathologic findings of idiopathic trachyonychia: An analysis of 30 adult patients

et al. 2020

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Background Trachyonychia, a rare inflammatory disease of the nail matrix, has a more chronic course in adults compared with that in children. However, the histopathologic features of the disease have not been sufficiently reported in the literature. Methods We retrospectively reviewed the pathologic features of idiopathic trachyonychia in adult cases at our center. Results A total of 30 cases were included. The median age was 55.5 years (range, 27‐77 years). Median disease duration was 84 months (range, 8‐384 months). Histopathologic analysis showed upper dermal lymphocytic infiltrates (93.3%), acanthosis (86.7%), exocytosis (63.3%), spongiosis (63.3%), parakeratosis (46.7%), psoriasiform hyperplasia (40%), eosinophilic infiltrates (33.3%), vacuolar degeneration (33.3%), lichenoid pattern (13.3%), Civatte body (6.7%), and collection of neutrophils in the stratum corneum (3.3%). Statistical analysis among pathologic parameters revealed associations of spongiosis with exocytosis (P < 0.001) and lichenoid infiltration with vacuolar degeneration (P = 0.008). Three patients (10%) showed fungal co‐infection. Conclusion The majority of cases revealed inflammatory cell infiltration with epidermal changes. Given the inflammation and chronic course of idiopathic trachyonychia in adulthood, active treatment with anti‐inflammatory agents should be considered. Additionally, mycological tests should be considered during initial evaluation as there are cases with fungal coinfection.

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Alitretinoin can be a good treatment option for idiopathic recalcitrant trachyonychia in adults: an open‐label study

Abstract: For the first time, this study evaluated the efficacy and safety of oral alitretinoin for idiopathic recalcitrant trachyonychia in adults. The results suggest that oral alitretinoin can be a good treatment option for adult patients with recalcitrant trachyonychia.

Cited by 6 publications

References 22 publications

Trachyonychia Secondary to Acitretin Usage

Trachyonychia Secondary to Acitretin Usage

Efficacy of Fluocinonide\Bifonazole Cream for the Treatment of Trachyonychia

Histopathologic findings of idiopathic trachyonychia: An analysis of 30 adult patients

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