Comparative evaluation of therapeutic efficacy of topical calcitriol occlusive dressing and cryotherapy with nitrous oxide in psoriatic fingernails

Background Nail psoriasis is often a therapeutic challenge due to its chronic nature and lack of consistent efficacy of available treatment modalities with several side effects limiting their prolonged use. This emphasizes the need for newer, more effective, and safe treatment options. Aims and objective Evaluate the therapeutic efficacy of cryotherapy with nitrous oxide in comparison with topical calcitriol ointment occlusive dressing in nail psoriasis. Patients and methods A nonrandomized controlled interventional study with intraindividual comparison, in 130 clinically diagnosed psoriatic fingernails. In each patient, at least one nail was subjected to daily topical calcitriol ointment occlusive dressing for 12 weeks. One nail was subjected to six sessions of cryotherapy biweekly for 12 weeks, while one nail was kept in control without any treatment. The severity of nail psoriasis was evaluated using Nail Area Psoriasis Severity Index scoring at baseline and every follow-up visit. Results were statistically analyzed at the end of 24 weeks. Results More than grade 3 (>50%) improvement was observed in 62% of fingernails treated with cryotherapy, in 72% of fingernails treated with topical calcitriol and only 23.3% of fingernails in the control group. Limitations Nonrandomized study with low sample size. Conclusion Cryotherapy is an effective treatment modality in nail psoriasis with therapeutic efficacy comparable to that of vitamin D analogs.