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

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. 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. 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%). Intramatricial TA is a safe and effective modality for treating trachyonychia.