Effectiveness and Safety of Intramatricial Triamcinolone Acetonide for Trachyonychia: A Retrospective Data Analysis.

Introduction: Trachyonychia is a clinical presentation characterised by dry, rough, longitudinally ridged nails or opalescent shiny nail plates with pits. Intramatricial steroids are an accepted form of therapy, but efficacy data are lacking.

Materials and methods: A retrospective data analysis of 6 patients (84 nails) with trachyonychia who received treatment for at least 6 sessions, with intramatricial triamcinolone acetonide (TA) (5 mg/mL), administered at 4 weekly intervals, was conducted. Photographic records were analysed for scoring severity of disease with Nail Surface Abnormality Index (NSI) score. Endpoint of therapy was 4 weeks after the sixth injection.

Results: Among the 6 patients analysed as per protocol, 4 had both finger and toenails involved, while 2 had only fingernails affected. Overall 56/60 fingernails (93.3%) and 28/60 toenails (46.6%) were affected in these patients, and were treated. The mean baseline NSI score for fingernails was 10.34 ± 4.1 (range 2-16) which improved to 6.61 ± 3.21 (range 0-12 at endpoint, showing a 37.86% reduction [p < 0.0001]). The mean baseline NSI score of toenails improved from 10.25 ± 3.51 (range 4-14) to 5.00 ± 1.91 (range 1-8) at endpoint, showing a 50.05% reduction (p < 0.0001). Adverse effects included pain (5.88%), subungual hematoma (5.88%), proximal nail fold hyperpigmentation (21.17%), and atrophy (22.35%).

Conclusion: Intramatricial TA is a safe and effective modality for treating trachyonychia.