Comparison of the efficacy of topical clobetasol propionate 0.05% cream, oral methotrexate and oral acitretin in nail psoriasis

Background: Prevalence of nail psoriasis among plaque psoriasis patients documented in the literature is over 50%, with an estimated lifetime incidence of 80-90%. Prevalence of isolated nail psoriasis is 5-10%.
Materials and Methods: This open label randomized study was conducted on patients of nail psoriasis. Patients were randomized into Group A (topical clobetasol propionate 0.05% cream under occlusion, once daily application) Group B (oral methotrexate 0.3mg/kg/week) and group C (oral acitretin 0.3mg/kg/day). Patients were followed-up after 4, 8 and 12 weeks, to measure improvement in Nail Psoriasis Severity Index (NAPSI), nail matrix and nail bed scores.
Results: All three drugs individually showed significant improvement in NAPSI and nail matrix scores. While improvement in nail bed score were significant in methotrexate (P=0.024) and acitretin (P=0.005) groups only. On inter groups comparison there was significant difference between group A and group B in the improvement of NAPSI (P=0.044) and nail matrix scores (P=0.024). No significant difference between group A and C, and Group B & C. While improvement in nail bed score was insignificant between groups.
Conclusions: All therapies were significantly effective and methotrexate was superior to topical clobetasol 0.05% cream in the improvement of NAPSI and nail matrix scores.