Dr. Savreet says that, presently, physicians use varying concentrations of TA to treat psoriatic fingernails, but no standards for dosing or treatment regimens exist.
"There's been little research done on this topic," Dr. Savreet says.
The few studies that exist generally focus on TA concentrations of either 5 mg/ml (Bleeker JJ. Br J Dermatol. 1974 Jul;91(1):97-101) or 10 mg/ml (de Berker DC, Lawrence CM. Br J Dermatol. 1998 Jan;138(1):90-95), and none of these studies compare different concentrations, she says.
As a result, Dr. Savreet says, "Physicians are usually afraid of using intramatrix injections. Maybe some of them don't know the technique," and others might fear that intramatrix injections of steroids will cause nail fold atrophy.
"Physicians usually use topical medications in the form of creams or ointments, which aren't very effective — there's not much absorption through the nail," Dr. Savreet says.
To compare and clinically validate the performance of various TA concentrations, Dr. Savreet and a colleague enrolled patients with a total of 90 psoriatic fingernails as a thesis project while Dr. Savreet was pursuing her M.D. credentials at the Government Medical College, Amritsar, India.
Investigators assessed each nail using the Nail Psoriasis Severity Index (Rich P, Scher RK. J Am Acad Dermatol. 2003 Aug;49(2):206-212) and divided the nails randomly into three groups of 30.
They treated patients in group A with TA 2.5 mg/ml, those in group B with 5 mg/ml and those in group C with 10 mg/ml. All patients received two intramatrix injections per nail, totaling 0.1 ml of solution at each sitting, Dr. Savreet tells Dermatology Times.
"I used three doses total, spaced six weeks apart. With the concentration of 10 mg/ml, I got good results," she says.
Dr. Savreet also took clinical photographs every six weeks for up to six months. Using these photos, investigators assessed improvement in pitting, discoloration and other parameters using a four-grade scale (grade 1= up to 25 percent improvement; 4= greater than 75 percent improvement).
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