Nail psoriasis successfully treated with intralesional methotrexate: case report

Area of Science:

• Dermatology
• Pharmacology
• Immunology

Background:

• Psoriasis affects nearly 3% of the population, with up to 90% of patients experiencing nail involvement, causing significant social distress.
• Current management of nail psoriasis lacks definitive treatment, with topical and systemic agents offering limited benefits and potential side effects.
• Methotrexate (MTX), a folic acid antagonist, inhibits DNA synthesis and possesses anti-inflammatory properties relevant to autoimmune diseases.

Observation:

• A case study involving a 26-year-old female patient with psoriatic nail dystrophy is presented.
• The patient was treated with low-dose intralesional methotrexate (MTX) injections.
• No adverse side effects were observed during the treatment period.

Findings:

• Successful treatment of nail psoriasis and associated nail dystrophy was achieved using low-dose intralesional MTX.
• The treatment demonstrated efficacy without the side effects commonly associated with conventional topical and systemic therapies for nail psoriasis.

Implications:

• Intralesional MTX injection emerges as a potentially safe and effective therapeutic option for managing nail psoriasis.
• Further large-scale, controlled studies are warranted to validate these findings and establish intralesional MTX as a standard treatment.
• This approach may offer a valuable alternative for patients experiencing limitations with existing nail psoriasis treatments.