Y.Y.WENG1, C.Z.Y.PHUAN2, X.ZHAO1, E.S.T.TAN1, H.L.TEY1
National Skin Centre1, Tan Tock Seng Hospital2
Nail psoriasis treatment is challenging due to difficult drug delivery and systemic therapy toxicities. Self-dissolvable microneedle patches embedded with corticosteroids offers a potentially rapid, minimally invasive drug delivery platform with good efficacy and minimal adverse side effects.
We conducted a 4-month prospective randomized controlled trial. Subjects with psoriatic nails were randomized to receive microneedle device delivered topical steroids on one hand and control treatment (topical Daivobet® gel) on the other. Two independent dermatologists blinded to the treatment assignment scored their Nail Psoriasis Severity Index (NAPSI) during visits at baseline, two and four months. All treatment was discontinued after 2 months. Average NAPSI score on each hand was analysed.
25 participants were recruited, aged 22 to 73-years-old. Majority were Chinese (72%), followed by Indians and Malays. There was equal randomization of treatment to the left and right nail. While there was a rapid significant improvement in average NAPSI score for the control arm at two months, the treatment arm had a greater, more sustained improvement of the NAPSI score at four months. The average NAPSI score improved for both treatment and control group at 4-months compared to baseline, but only the NAPSI value improvement in the controls at 2-months compared to baseline was statistically significant (p=0.0039). No severe adverse effects were reported.
This is the first prospective randomized control trial comparing microneedle technology against conventional topical steroids in nail psoriasis treatment. Our findings demonstrate microneedle technology is as efficacious as topical therapy.