PSORIASIS INVOLVING NAILS From: Brad.Becker@ncal.kaiperm.org I am following a 33 year old postal worker with painful nail psoriasis. The patient has been unresponsive to efudex, temovate, and mandelic acid. He is not agreeable to methotrexate, or etretinate. Intralesional steroids are moderately effective. Given that he works outdoors all day in California PUVA is impractical. Does anyone have experience with topiPUVA in this setting? Anyone with experience with longterm intralesional steroids? Other ideas? ==================== From: KSmithDerm@aol.com I've had some success with Dovonex ointment, often with 10% urea and 2.5% HC added, applied to the proximal nailfold bid. Caution them not to force it into the nailfold or put it under the nail. I photograph them all, because improvement takes months, and the photos make it easier to assess progress and encourage compliance. ================ From: Haines Ely I just saw a patient who reminded me of your request for psoriasis nail Rx. The patient came back after a year and a half for a refill of his Azulfadine. I had treated his extensive psoriasis with 500mg po QID. He cleared completely and I lost him to follow up. When he came back he looked fine. He wanted more Azulfadine because his nails were starting to pit again after being off for several months.Its a relatively benign therapy compared to MTX or etretinate and works in about a third of the patients. Try it for three or four months before deciding if its going to work. Haines Ely, Grass Valley, Ca.