clobetasol and Nail-Diseases

Periungual pyogenic granulomas are benign vascular tumors that present as painful, round, spontaneously bleeding lesions composed of rapidly proliferating capillaries and excess tissue. The vast majority of pyogenic granulomas are caused by physical trauma or infectious agents and they may resolve spontaneously. Herein, we highlight a very rare case of periungual pyogenic granulomas induced by the regularly prescribed oral retinoid acitretin during treatment for congenital palmoplantar keratoderma. This unique case showed that it is feasible to continue acitretin therapy in the presence of pyogenic granuloma development if proper dose reduction and topical therapies are utilized. The patient's lesions resolved within two weeks of this protocol's initiation and the pyogenic granulomas did not recur over the course of a six-month follow-up observation period. In addition, we performed a systematic review of the literature using PubMed databases for the clinical features and treatments in other reported acitretin-induced pyogenic granuloma cases; we compiled a comprehensive list of other prescription drugs known to cause pyogenic granulomas up-to-date.

Topics: Acitretin; Administration, Oral; Adult; Anti-Bacterial Agents; Clobetasol; Glucocorticoids; Granuloma, Pyogenic; Humans; Keratoderma, Palmoplantar; Keratolytic Agents; Male; Mupirocin; Nail Diseases

Even though the traditional therapy for nail psoriasis has been used for decades, no randomized, controlled trial of such treatment has been conducted to date.. To evaluate the efficacy and safety of intralesional triamcinolone injections compared with 0.05% clobetasol ointment for psoriatic nails.. Psoriasis patients, each with three fingernails with similar degrees of severity, were randomly recruited for intralesional triamcinolone injection group, 0.05% clobetasol ointment group, and a control group. The target Nail Psoriasis Severity Index (NAPSI) score of each finger was evaluated, any adverse effects were recorded, and photographs were taken.. Forty-eight affected nails were analyzed. At the second month, a significantly greater reduction of the target NAPSI score was observed in the injection group compared to the control group (p = .003). There was a greatest reduction of the score in the following two month-period, which showed significant difference from the topical group (p = .003) and the control group (p = < .001). The score of the injection group, however, subsequently rose at the six-month visit so that there was no longer any statistically-significant difference between the three groups.. In spite of its temporary effect, the intralesional triamcinolone injection is an effective and safe treatment for psoriatic nails.

Topics: Adult; Aged; Clobetasol; Female; Humans; Injections, Intralesional; Male; Middle Aged; Nail Diseases; Ointments; Psoriasis; Single-Blind Method; Triamcinolone

Topics: Administration, Topical; Clobetasol; Dermatologic Agents; Double-Blind Method; Humans; Keratolytic Agents; Nail Diseases; Nicotinic Acids; Psoriasis

Topics: Administration, Topical; Anti-Inflammatory Agents; Calcitriol; Clobetasol; Dermatologic Agents; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Male; Middle Aged; Nail Diseases; Ointments; Psoriasis

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Antifungal Agents; Clobetasol; Dermatitis, Allergic Contact; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Imidazoles; Male; Nail Diseases; Toes

Topics: Administration, Cutaneous; Adolescent; Adult; Anti-Inflammatory Agents; Clobetasol; Female; Humans; Male; Middle Aged; Nail Diseases; Pilot Projects; Psoriasis; Severity of Illness Index; Young Adult

Topics: Administration, Topical; Adolescent; Age Factors; Child; Clobetasol; Cohort Studies; Female; Follow-Up Studies; Humans; Male; Nail Diseases; Nails; Nails, Ingrown; Nails, Malformed; Ointments; Paronychia; Recurrence; Retrospective Studies; Risk Assessment; Severity of Illness Index; Toes; Treatment Outcome; Young Adult

A man, 58 years of age, presented with a 4 year history of painful lesions of his nails. His previous history included hypertension, diabetes mellitus and hyperlipidaemia. These were treated with enalapril, metformin and simvastatin respectively. He also had asymptomatic skin lesions for over 15 years that had worsened in the past 4 years. His father had similar nail lesions that had been diagnosed as onychomycosis.

Topics: Clobetasol; Dermatologic Agents; Glucocorticoids; Humans; Male; Methotrexate; Middle Aged; Nail Diseases; Onycholysis; Pain; Psoriasis; PUVA Therapy

Nail involvement is a common and distressing feature in the course of psoriasis. Although much progress has been made in the treatment of the disease, the presence of psoriasis in the nail continues to pose a challenge. In recent years, vitamin D3 analogs and a new formulation containing 8% clobetasol-17-propionate in a colourless nail lacquer vehicle have produced good results for the control of nail psoriasis.. To determine the efficacy and safety of the combined treatment of 8% clobetasol-17-propionate in a lacquer vehicle and tacalcitol ointment in nail psoriasis.. Fifteen patients with both nail bed and nail matrix psoriasis were included in the study. They were treated with a colourless nail lacquer containing 8% clobetasol-17-propionate applied at bedtime at the weekend, and with tacalcitol ointment under occlusion on the remaining days, for 6 months.. All 15 patients responded well to treatment. The therapeutic effect was very fast and directly related to the length of therapy. All nail alterations, including nail pain, were reduced, and the modified target Nail Psoriasis Severity Index fell by an average of 78% compared to baseline levels (+/-59.6, P < 0.0001).. Combined treatment with tacalcitol ointment and 8% clobetasol-17-propionate in a nail lacquer is a safe, effective treatment for nail bed and nail matrix psoriasis.

Topics: Administration, Topical; Adult; Aged; Anti-Inflammatory Agents; Clobetasol; Dihydroxycholecalciferols; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Nail Diseases; Ointments; Psoriasis; Treatment Outcome

Lichen planus of the nails is a destructive inflammatory onychodystrophy that is often difficult to treat. We report a case of treatment with combined topical therapy of tazarotene gel and clobetasol gel. This modality may be effective for patients with nail lichen planus without the potential adverse affects of systemic treatments.

Topics: Administration, Topical; Aged; Clobetasol; Drug Therapy, Combination; Female; Gels; Humans; Lichen Planus; Nail Diseases; Nicotinic Acids; Palliative Care

A 45-year-old woman was referred to the dermatology clinic for assessment of "refractory onychogryphosis." She had a 3-year history of lesions involving distal phalanges of the first and third of her left foot. Initially she described periungual erythema and swelling. Three weeks later she noted a whitish growth and thickening of her third toenail. X-ray films of the digit were reported as normal. Several months later the same changes occurred in her great toe. These lesions were asymptomatic. There was no history of trauma. Numerous fungal cultures were negative. No light microscopic examinations were undertaken. She had a trial of both topical and systemic terbinafine of 3-months duration with no clinical improvement. Several clinical opinions were obtained from two dermatologists, a surgeon, and a chiropodist. Past medical history of note was significant for tubal ligation, cervical cancer, and chronic sinusitis. The latter condition in retrospect was thought to be secondary to sarcoidosis. Physical examination revealed periungual violaceous discolouration of the first and third toes of the left foot. There was evidence of significant nail changes including dystrophy, onycholysis, and hyperkeratosis (Fig. 1). The fingernails were normal. There were no other skin abnormalities. A punch biopsy of the tip of the third toe showed granulomatous inflammation. There was evidence of hyperkeratosis, exocytosis, and a dense infiltrate composed of collections of histiocytes and a few giant cells forming granulomas (Fig. 2). Repeat x-ray films of the foot showed soft tissue swelling of the first and third digits. There was bony resorption in the distal phalanges with a lacey trabecular pattern compatible with sarcoidosis (Fig. 3). Chest x-ray films revealed marked hilar adenopathy. The patient was sent to a respirologist who concurred with the diagnosis of sarcoidosis. Further investigations included a low serum calcium of 2.07 mmol/L, serum ACE of 70 U/L (upper limit of normal is 75), Wintrobe erythrocyte sedimentation rate (ESR) of 10 mm per hour, thyroid stimulating hormone concentration of 0.65 mU/L, and a urinary calcium excretion rate that was elevated at 7.3 mmol/day. Pulmonary function tests were unremarkable. The patient was initially treated with clobetasol under occlusion and intralesional triamcinolone with minimal improvement. She was subsequently started on prednisone, 15 mg per os daily because of the lung and bone involvement with significant impro

Topics: Administration, Topical; Anti-Inflammatory Agents; Clobetasol; Diagnosis, Differential; Female; Glucocorticoids; Humans; Middle Aged; Nail Diseases; Nails, Malformed; Prednisone; Radiography; Sarcoidosis; Toes; Triamcinolone