skip to main content

Psoriatic Nail Disease — SCE Dermatology MCQ

Instant feedback + full explanation. One question, done properly.

ModerateNail DisordersPsoriatic Nail DiseaseSCE Dermatology

A 38-year-old man with nail psoriasis has been treated with topical corticosteroids and calcipotriol under occlusion without adequate response. His nail changes are causing significant functional and psychological impact (Nail Psoriasis Severity Index >8). What is the recommended treatment escalation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Intralesional triamcinolone injection into the nail matrix

For psoriatic nail disease refractory to topical therapy, intralesional triamcinolone acetonide injection into the proximal nail fold/nail matrix is the recommended next step. This delivers corticosteroid directly to the site of nail plate production. The injection technique targets the nail matrix (for pitting, ridging, crumbling) or nail bed (for onycholysis, subungual hyperkeratosis, oil drop sign). If intralesional steroids fail, systemic therapy (Methotrexate, Ciclosporin, Acitretin, or biologics) should be considered. Biologic therapies, particularly anti-IL-17 agents, have demonstrated high efficacy for nail psoriasis.

Reference: BAD 2020 Psoriasis Guidelines; NICE