Intralesional steroid treatment for the intermediate stage of retronychia: A pilot study

Abstract

Retronychia describes the proximal ingrowing of the nail plate. In the early stage, topical steroids are the gold standard therapy, while in the late stage surgical treatment is mandatory. We identified an intermediate severity stage of retronychia, where the topical treatment alone is ineffective and surgery is avoidable. Intralesional steroids turn the best treatment in these patients. A pilot study consisting of a 3-month treatment period and 9-month follow-up time was designed to evaluate the treatment outcome to intralesional steroid injections in patients affected by the intermediate-stage of toenail retronychia. The complete recovery of retronychia-associated nail abnormalities was observed in 27/28 recruited patients at the end of the treatment phase. Paronychia, nail plate discoloration, proximal nail fold (PNF) elevation, and discharge were reduced (P < .01) after one steroid administration, while nail regrowth became significant after two sessions. No significant difference in terms of clinical outcome was found, while pain VAS score and intra-operative pain evaluated with Wong-Baker faces scale were higher in the female group (P < .01). Limitation Lack of control group of patients. Despite its temporary effect, the intralesional triamcinolone injection is an effective, cheap, and safe treatment especially for the intermediate stage of retronychia.

Treatment of retronychia: A systematic review and suggested treatment algorithm

“…Medical management induced cure rates of 62.5% for chemical avulsion and of 96.4% for intralesional steroid injections (with a recurrence rate of 12.5% and 0%, respectively). As described by Alessandrini et al, 29 intralesional steroid injections induced cure of retronychia as early as after two injections. Topical steroids and podiatric treatment showed a low rate of success (47.3% and 15.4%, respectively) and a 1.7% relapse rate for topical steroids.…”

“…In 17/93 cases, nail avulsion was pursued after the failure of topical therapy, based on antibiotics or corticosteroids 1 . In one case, surgery was advocated after the lack of response to an intralesional cycle of steroids 29 . Cure rate was computed as the percentage of completely resolved cases minus relapse events on the total population (Table 3).…”

“…1 In one case, surgery was advocated after the lack of response to an intralesional cycle of steroids. 29 Cure rate was computed as the percentage of completely resolved cases minus relapse events on the total population (Table 3).…”

“…13,28 Among the conservative treatments, matrix intralesional injection of triamcinolone resulted in a cure rate of 96.43% in a single monocentric prospective study. 29 This approach can be advocated in intermediate or early stages, when surgery can still be spared. There is no evidence to support the use of triamcinolone in severe cases.…”

“…As suggested by the study by Alessandrini et al the action of intralesional steroids can improve slowed nail growth, exerting a beneficial effect on the matrix. 29 The use of high potency topical steroids led to a cure rate of 41.60%. However, this could possibly be higher if limited to early stages, where inflammation of the proximal nail fold could be reduced with good efficacy.…”