What is the role of intralesional injection in the treatment of onycholysis?

Updated: Nov 20, 2020
  • Author: Melanie S Hecker, MD, MBA; Chief Editor: William D James, MD  more...
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Answer

Intralesional injection may be required for onycholysis associated with more severe psoriatic nail dystrophy. Note the following:

  • Triamcinolone 2.5-5 mg/mL diluted with normal saline is injected into the proximal nail fold every 4 weeks in a series of 4-6 sessions.

  • The proximal nail fold overlying the nail matrix is the ideal site for treatment of diseases that begin at the matrix (eg, psoriasis).

  • A 30-gauge needle is adequate for medication delivery; a topical anesthetic may be used to reduce pain.

  • Improvement should start after the initial series; continued injections depend on disease recurrence.

  • For other nail changes associated with onycholysis (eg, oil drop sign of psoriasis, distal onycholysis, subungual hyperkeratosis), the ideal location for intralesional injection is the nail bed. The pain of this procedure necessitates the use of anesthesia. This problem can be overcome by injecting the lateral nail folds in an attempt to get medication to the affected area.


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