A Pilot Study on the Role of Intralesional Triamcinolone Acetonide in the Treatment of Pitted Nails in Children

BP Khoo, YC Giam
Correspondence: Dr B P Khoo

ABSTRACT
Background Pitted nails is a non-specific entity seen in children that is often associated with various underlying skin disorders such as atopic dermatitis, psoriasis, alopecia areata and lichen planus; and those without such associations are labelled as idiopathic pitted nails. Spontaneous resolution is common but may take several years. Treatment options so far have not been encouraging. This pilot study sought to determine the safety and efficacy of intralesional steroid in the treatment of pitted nails in children.
Method Children with pitted nails below the age of 12, seen between January 1994 and December 1997, were invited to participate in this study. Symmetrically affected fingernails were selected, topical anaesthetic cream applied and a single dose of triamcinolone acetonide was introduced intralesionally to the proximal nailfold while the contralateral nail acted as control. The degree of pitting of nail surface was documented at months 0, 2 and 4.
Results Four children were enrolled, and their ages ranged from 4 to 9 years. The degree of pitting was reduced to a mean of 15% of the nail surface in the second month, and 42% in the fourth month. The procedure was fairly well tolerated and no adverse effects were noted.
Conclusion Intralesional steroid is a safe and acceptable method of treating pitted nails in children with a maximum effect seen in 2 months. In order to sustain a continuous therapeutic effect, a bimonthly treatment is suggested.

Keywords: pitted nails, trachyonychia, intralesional steroid, bimonthly treatment
Singapore Med J 2000; 41(2): 66-68