Safety and efficacy of intralesional triamcinolone in the treatment of nail psoriasis: A systematic review and meta-analysis
DOI:
https://doi.org/10.25251/jdqy1c05Keywords:
corticosteroids, intralesional, nail, psoriasis, triamcinoloneAbstract
Nail psoriasis is a chronic and disfiguring manifestation of psoriasis that substantially affects quality of life. Intralesional triamcinolone acetonide (ILTAC) is commonly used for localized disease, yet its efficacy and safety remain incompletely established. This systematic review and meta-analysis aimed to evaluate the therapeutic effectiveness and safety of ILTAC in nail psoriasis and to summarize key clinical and methodological features of available studies. The review followed PRISMA guidelines and was registered in the PROSPERO database. Comprehensive searches of 5 electronic databases through September 2023 identified 6 eligible studies, including randomized trials and observational cohorts, that evaluated ILTAC using standardized outcome measures such as the Nail Psoriasis Severity Index. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB2) tool for randomized trials and the MINORS tool for nonrandomized studies. Pooled analysis demonstrated that ILTAC significantly improved nail psoriasis, with an overall odds ratio of 2.35 (95% CI, 1.20–4.60) and negligible heterogeneity (I²= 0%). Adverse events were generally mild and transient, with pain being the most frequently reported side effect, and no systemic adverse reactions were noted. These findings confirm that ILTAC is an effective and safe localized therapy for nail psoriasis, although optimal maintenance strategies require further investigation.
References
1. Bedair NI, EL-Komy MHM, Elhamy N, Hafez V. Nail Involvement Among Psoriasis Patients: A Comparative Retrospective Cohort Analysis of 2888 Egyptian Patients. Exp Dermatol. 2025;34:e70105. doi:10.1111/EXD.70105. PMID:40289669
2. Stewart CR, Algu L, Kamran R, Leveille CF, Abid K, Rae C, et al. The Impact of Nail Psoriasis and Treatment on Quality of Life: A Systematic Review. Skin Appendage Disord. 2021;7:83-89. doi:10.1159/000512688. PMID:33796553
3. Langley RG, Daudén E. Treatment and management of psoriasis with nail involvement: a focus on biologic therapy. Dermatology. 2010;221 Suppl 1:29-42. doi:10.1159/000316179. PMID:20733313
4. Rich P, Scher RK. Nail Psoriasis Severity Index: A useful tool for evaluation of nail psoriasis. J Am Acad Dermatol. 2003;49:206-212. doi:10.1067/S0190-9622(03)00910-1. PMID:12894066
5. Busard CI, Nolte JYC, Pasch MC, Spuls PI. Reporting of outcomes in randomized controlled trials on nail psoriasis: a systematic review. Br J Dermatol. 2018;178:640-649. doi:10.1111/BJD.15831. PMID:28722209
6. Ricardo JW, Lipner SR. Nail Psoriasis in Older Adults: Intralesional, Systemic, and Biological Therapy. Dermatol Clin. 2021;39:195-210. doi:10.1016/J.DET.2020.12.012. PMID:33745633
7. Crowley JJ, Weinberg JM, Wu JJ, Robertson AD, Van Voorhees AS. Treatment of nail psoriasis: best practice recommendations from the Medical Board of the National Psoriasis Foundation. JAMA Dermatol. 2015;151:87-94. doi:10.1001/JAMADERMATOL.2014.2983. PMID:25471223
8. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. The BMJ. 2021:372. doi:10.1136/bmj.n71. PMID:33782057
9. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. The BMJ. 2019;2019:366. doi:10.1136/bmj.l4898.PMID:31462531
10. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (Minors): Development and validation of a new instrument. ANZ J Surg. 2003;2003:73. doi:10.1046/j.1445-2197.2003.02748.x. PMID:12956787
11. Nantel-Battista M, Richer V, Marcil I, Benohanian A. Treatment of nail psoriasis with intralesional triamcinolone acetonide using a needle-free jet injector: A prospective trial. J Cutan Med Surg. 2014;2014:18. doi:10.2310/7750.2013.13078. PMID:24377472
12. Mittal J, Mahajan BB. Intramatricial injections for nail psoriasis: An open-label comparative study of triamcinolone, methotrexate, and cyclosporine. Indian J Dermatol Venereol Leprol. 2018:84. doi:10.4103/ijdvl.IJDVL_73_16. PMID:29536977
13. Boontaveeyuwat E, Silpa-Archa N, Danchaivijitr N, Wongpraparut C. A randomized comparison of efficacy and safety of intralesional triamcinolone injection and clobetasol propionate ointment for psoriatic nails. Journal of Dermatological Treatment. 2019;2019:30. doi:10.1080/09546634.2018.1476647. PMID:29781308
14. Starace M, Alessandrini A, Iorizzo M, D’Altobrando A, Ferrari T, Bruni F, et al. A pilot study of intralesional methotrexate injections versus triamcinolone acetonide in patients affected by nail matrix psoriasis. Clin Exp Dermatol. 2022;47:1165-1168. doi:10.1111/CED.15110. PMID:35118697
15. Abdelmeniem IM, El Eryan IM, Nofal A, Fouda I, Omar SS. Topical calcipotriol combined with urea 20% versus intralesional injection of triamcinolone acetonide, 5-fluorouracil, and methotrexate in the treatment of nail psoriasis: A comparative study. Dermatol Ther. 2022:35. doi:10.1111/DTH.15660. PMID:35730342
16. Srisinlapakig S, Juntongjin P. Intralesional Triamcinolone Acetonide Injection and Topical Betamethasone/Calcipotriol Treatment in Nail Psoriasis. Published online 2022.
17. Rigopoulos D, Baran R, Chiheb S, Daniel CR, Di Chiacchio N, Gregoriou S, et al. Recommendations for the definition, evaluation, and treatment of nail psoriasis in adult patients with no or mild skin psoriasis: A dermatologist and nail expert group consensus. J Am Acad Dermatol. 2019;81:228-240. doi:10.1016/J.JAAD.2019.01.072. PMID:30731172
18. Yoo KH, Bang DS, Han HS, Li K, Kim BJ. Intralesional triamcinolone injections for the treatment of nail dystrophy: A case series. Dermatol Ther. 2020:33. doi:10.1111/DTH.13427. PMID:32301144
19. Grover C, Kharghoria G, Bansal S. Triamcinolone Acetonide Injections in Nail Psoriasis: A Pragmatic Analysis. Skin Appendage Disord. 2024;10:50-59. doi:10.1159/000534699. PMID:38313569
20. Üstüner P, Balevi A, Özdemir M. The Comparison of the Efficacy and Safety of Intralesional Triamcinolone Acetonide and Methotrexate Injections for the Treatment of Fingernail Psoriasis. J Ankara Univ Fac Med. 2018;71:145-151. doi:10.4274/ATFM.43534
21. Saleem K, Azim W. Treatment of nail psoriasis with a modified regimen of steroid injections. J Coll Physicians Surg Pak. 2008;18:78-81. PMID:18454890
22. De Berker DAR, Lawrence CM. A simplified protocol of steroid injection for psoriatic nail dystrophy. Br J Dermatol. 1998;138:90-95. doi:10.1046/j.1365-2133.1998.02031.x. PMID:9536228
23. Alakad R, Nassar A, Atef H, Eldeeb F. Fractional CO2 Laser-Assisted Delivery Versus Intralesional Injection of Methotrexate in Psoriatic Nails. Dermatol Surg. 2022;48:539-544. doi:10.1097/DSS.0000000000003418. PMID:35333217
24. Grover C, Daulatabad D, Singal A. Role of nail bed methotrexate injections in isolated nail psoriasis: conventional drug via an unconventional route. Clin Exp Dermatol. 2017;42:420-423. doi:10.1111/CED.13087. PMID:28397295
25. Peachey RDG, Pye RJ, Harman RRM. The treatment of psoriatic nail dystrophy with intradermal steroid injections. Br J Dermatol. 1976;95:75-78. doi:10.1111/J.1365-2133.1976.TB15536.X. PMID:952744
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Data Availability Statement
The data supporting the findings of this study are available from the corresponding author upon request. All data extracted and analyzed during the systematic review are derived from previously published studies that are publicly accessible through indexed databases.
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Copyright (c) 2026 Abdulaziz Madani, Maee Barakeh, Naif Alshehri, Ibraheem Altamimi, Shaden Alobaid (Author)

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