Comparison of nail lacquer clobetasol efficacy at 0,05%, 1% and 8% in nail psoriasis treatment: prospective, controlled and randomized pilot study

Abstract

BACKGROUND: Nail psoriasis may affect up to 90% of patients with psoriasis in the course of the disease throughout their lives and it is often a therapeutic challenge to dermatologists. Topical treatments described in the literature have demonstrated variable efficacy, and unsatisfactory results have been associated to inefficient penetration of the active ingredient into the nail plate and proximal nail fold. Recently the use of clobetasol on nail lacquer vehicle has been suggested, with satisfactory results and no side effects. OBJECTIVE: To determine the efficacy and safety of clobetasol in nail lacquer vehicle in three concentrations (0.05%, 1% and 8%) in patients with nail psoriasis. METHODS: Prospective, controlled, randomized pilot study in fifteen patients with nail bed and/or nail matrix psoriasis in both hands, subdivided into three groups: A(0.05% clobetasol nail lacquer), B(1% clobetasol nail lacquer) and C(8% clobetasol nail lacquer). All groups used clobetasol nail lacquer on the left hand and base coat nail lacquer as control on the right, twice a week for 16 weeks. Clinical evaluation was done by photographic records and the NAPSI score of both treated and control hands, as well as modified NAPSI score of the most affected nail of the treated hand. RESULTS: Group C showed a statistically relevant clinical response compared to the other groups, reflected in the improvement of clinical parameters, of treated hand NAPSI score, when compared to the control hand, and modified NAPSI score of the most affected nail in the treated hand. CONCLUSION: The 8% clobetasol nail lacquer was effective and safe, and it can be considered a good option of topical therapy in the treatment of nail psoriasis.

Reporting of outcomes in randomized controlled trials on nail psoriasis: a systematic review

“…Overall, 74% of studies assessed one or more types of NAPSI. A target NAPSI was most commonly used, with assessment in 27% of studies on a scale of 0–8 . A modified NAPSI was used in 22% of studies with assessment on scales of 0–24 (degree of severity for nail matrix and nail bed features), 0–96 (degree of severity for each nail matrix and bed feature assessed separately in each quadrant), 0–14 (degree of severity for crumbling, onycholysis and pitting only) or on a scale that was not defined .…”

Treatment of Nail Psoriasis: Common Concepts and New Trends

“…The nail lacquer is a solution that helps to prevent the adverse effects caused by the use of intralesional corticosteroids or corticosteroids in cream or gel applied to the skin. Consequently favorable results have been observed with 8% clobetasol propionate lacquer that has effective transungual penetration and therapeutic effect both on nail bed and matrix lesions, while lacking side effects [17, 23]. …”

Randomized controlled trial of a water-soluble nail lacquer based on hydroxypropyl-chitosan (HPCH), in the management of nail psoriasis

“…Many products have been used in the topical treatment of nail psoriasis; corticosteroids and vitamin D analogs are still the most frequently used topical therapies found in literature 8. However, none of them have been fully satisfactory, thus determining a real clinical need for new therapeutic options.…”