Trial of Topical Tacrolimus by Two Different Concentrations in Treatment of Nail Psoriasis: Randomized Comparative Study

Abstract

Background: Nail affection is estimated to affect about 85% of cases with psoriasis vulgaris (PV) in their lifetimes and is frequently  accompanied by severe disease and impairment of quality of life (QoL). Tacrolimus (0.1-0.03%) ointment was demonstrated to be efficient  in PV owing to its immunosuppressive characteristics. Regarding its therapeutic effect on nail psoriasis (NP), it appeared to be  similarly efficient on nail bed and matrix lesions without having extensive adverse events.

Objectives: Since previous trials on topical  tacrolimus in treatment of NP was concentrating only on the higher concentration (0.1%), which is more expensive and frequently not  available in many developing countries, the present study aimed to evaluate and compare the efficacy and safety of topical tacrolimus by  the two concentrations (0.1% and 0.03%) in treatment of nail psoriasis.

Patients and Methods: This randomized comparative study  comprised 50 patients with nail psoriasis; half of them were treated by tacrolimus 0.1% (group A) and the other half by tacrolimus 0.03%  (group B). Five patients from each group were lost follow up so the statistics involved only 20 cases in each group, the assessment of  disease severity was conducted by using Nail Psoriasis Severity Index (NAPSI) score.

Results: There was a statistically significant decrease  in NAPSI score starting 1 month after initiation of treatment in both groups. Although improvement frequency was better in  group A than group B but the difference was not statistically significant.

Conclusion: both concentrations of topical calcineurin inhibitors  (0.1% and 0.03%) showed high statistically significant improvement in NP after six months of treatment. Additionally topical calcineurin  inhibitors demonstrated no side effects, so they are safe and tolerable drugs in the context of NP treatment.