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• W2095670555 abstract "To the Editor: The treatment for simple onycholysis remains a challenge because it tends to be refractory, and a standardized therapeutic regimen does not exist. This prospective open-label study was designed to evaluate the efficacy and safety of a calcipotriol plus betamethasone dipropionate ointment in the treatment of simple onycholysis. The study was approved by the ethics committee, and voluntary informed consent was obtained in written form from all of the participants.In all, 47 patients with simple onycholysis applied the 2-compound product of calcipotriol plus betamethasone dipropionate ointment (Daivobet, LEO Pharma A/S, Ballerup, Denmark) once daily into the nail bed under the detached nail plate without occlusion for 6 months. Clinical outcomes were assessed at baseline and 1, 2, 3, and 6 months after treatment. We evaluated the patients with physician global assessment (PGA) using the onycholysis grading system proposed by Daniel et al.1Daniel C.R. Iorizzo M. Piraccini B.M. Tosti A. Grading simple chronic paronychia and onycholysis.Int J Dermatol. 2006; 45: 1447-1448Crossref PubMed Scopus (29) Google Scholar For statistical analysis, we added stage 0 as no evidence of onycholysis. A complete response was defined as no involvement of onycholysis, and a partial response was defined as an improvement of more than 1 stage of the PGA. All adverse events that occurred during treatment were recorded. To evaluate the outcome measures during the period of treatment, t tests were performed with Predictive Analytics Software (PASW for Windows, IBM Corp, Armonk, NY). P values less than .05 were considered statistically significant.Of 47 patients, 41 (87.2%) completed the 6-month study. A total of 41 patients (9 male and 32 female; age range, 4-74 years; mean age, 41 years) had 193 nails that were involved at baseline (156 fingernails and 37 toenails), and the mean duration of disease was 44.4 months (1-432 months).The mean PGA score at baseline was 2.1 ± 0.8 and, at the end of the treatment period, it was reduced to 0.9 ± 0.8 with statistical significance. The PGA score decreased consistently during the treatment period, and the scores were 1.7 ± 0.8, 1.4 ± 0.7, and 1.1 ± 0.7 at 1, 2, and 3 months, respectively. A clinical example is shown in Fig 1.At baseline, 43 (22.3%) digits were in stage I, 99 (51.3%) were in stage II, 36 (18.7%) were in stage III, and 15 (7.8%) were in stage IV. At the end of the treatment period, 63 (32.6%) digits showed a complete response, 91 (47.2%) were in stage I, 34 (17.6%) were in stage II, and 5 (2.6%) were in stage III (Table I). Adverse effects were found in 2 (4.9%) patients who had mild pruritus and in 1 (2.4%) patient who had hypopigmentation of the fingertip, and these were transient and self-limited.Table ISummary of treatment resultsn, (%)1 mo2 mo3 mo6 moStage I (n = 43) CR5 (11.6)7 (16.3)24 (55.8)27 (62.8)Stage II (n = 99) PR34 (34.3)65 (65.7)77 (77.8)54 (54.5) CR2 (2.0)2 (2.0)5 (5.1)31 (31.3)Stage III (n = 36) PR17 (47.2)24 (66.7)28 (77.8)27 (75.0) CR0 (0.0)0 (0.0)3 (8.3)5 (13.9)Stage IV (n = 15) PR15 (100.0)15 (100.0)15 (100.0)15 (100.0) CR0 (0.0)0 (0.0)0 (0.0)0 (0.0)Total (n = 193) PR66 (34.2)104 (53.9)120 (62.2)96 (49.7) CR7 (3.6)9 (4.7)32 (16.6)63 (32.6)CR, Complete response; PR, partial response. Open table in a new tab We started this study with the simple idea that a calcipotriol/betamethasone ointment could be effective in the treatment of simple onycholysis as it is in psoriatic nail, and we found that our suggestion was right.2Rigopoulos D. Gregorou S. Daniel C.R. Belyayeva H. Larios G. Verra P. et al.Treatment of nail psoriasis with a two-compound formulation of calcipotriol plus betamethasone dipropionate ointment.Dermatology. 2009; 218: 338-341Crossref PubMed Scopus (46) Google Scholar We suggest that topical calcipotriol/betamethasone ointment could be effective for simple onycholysis, and used as monotherapy for onycholysis, especially in stages I and II. To the Editor: The treatment for simple onycholysis remains a challenge because it tends to be refractory, and a standardized therapeutic regimen does not exist. This prospective open-label study was designed to evaluate the efficacy and safety of a calcipotriol plus betamethasone dipropionate ointment in the treatment of simple onycholysis. The study was approved by the ethics committee, and voluntary informed consent was obtained in written form from all of the participants. In all, 47 patients with simple onycholysis applied the 2-compound product of calcipotriol plus betamethasone dipropionate ointment (Daivobet, LEO Pharma A/S, Ballerup, Denmark) once daily into the nail bed under the detached nail plate without occlusion for 6 months. Clinical outcomes were assessed at baseline and 1, 2, 3, and 6 months after treatment. We evaluated the patients with physician global assessment (PGA) using the onycholysis grading system proposed by Daniel et al.1Daniel C.R. Iorizzo M. Piraccini B.M. Tosti A. Grading simple chronic paronychia and onycholysis.Int J Dermatol. 2006; 45: 1447-1448Crossref PubMed Scopus (29) Google Scholar For statistical analysis, we added stage 0 as no evidence of onycholysis. A complete response was defined as no involvement of onycholysis, and a partial response was defined as an improvement of more than 1 stage of the PGA. All adverse events that occurred during treatment were recorded. To evaluate the outcome measures during the period of treatment, t tests were performed with Predictive Analytics Software (PASW for Windows, IBM Corp, Armonk, NY). P values less than .05 were considered statistically significant. Of 47 patients, 41 (87.2%) completed the 6-month study. A total of 41 patients (9 male and 32 female; age range, 4-74 years; mean age, 41 years) had 193 nails that were involved at baseline (156 fingernails and 37 toenails), and the mean duration of disease was 44.4 months (1-432 months). The mean PGA score at baseline was 2.1 ± 0.8 and, at the end of the treatment period, it was reduced to 0.9 ± 0.8 with statistical significance. The PGA score decreased consistently during the treatment period, and the scores were 1.7 ± 0.8, 1.4 ± 0.7, and 1.1 ± 0.7 at 1, 2, and 3 months, respectively. A clinical example is shown in Fig 1. At baseline, 43 (22.3%) digits were in stage I, 99 (51.3%) were in stage II, 36 (18.7%) were in stage III, and 15 (7.8%) were in stage IV. At the end of the treatment period, 63 (32.6%) digits showed a complete response, 91 (47.2%) were in stage I, 34 (17.6%) were in stage II, and 5 (2.6%) were in stage III (Table I). Adverse effects were found in 2 (4.9%) patients who had mild pruritus and in 1 (2.4%) patient who had hypopigmentation of the fingertip, and these were transient and self-limited. CR, Complete response; PR, partial response. We started this study with the simple idea that a calcipotriol/betamethasone ointment could be effective in the treatment of simple onycholysis as it is in psoriatic nail, and we found that our suggestion was right.2Rigopoulos D. Gregorou S. Daniel C.R. Belyayeva H. Larios G. Verra P. et al.Treatment of nail psoriasis with a two-compound formulation of calcipotriol plus betamethasone dipropionate ointment.Dermatology. 2009; 218: 338-341Crossref PubMed Scopus (46) Google Scholar We suggest that topical calcipotriol/betamethasone ointment could be effective for simple onycholysis, and used as monotherapy for onycholysis, especially in stages I and II. Simple onycholysis: A diagnosis of exclusionJournal of the American Academy of DermatologyVol. 70Issue 4PreviewTo the Editor: We read with interest the article by Park and colleagues regarding the efficacy of combination treatment with calcipotriol and betamethasone diproprionate ointment for treatment of simple onycholysis.1 In their prospective open-label study, they treated 47 patients with combination therapy to the nail bed under occlusion and reported improvement in physician global assessment scores at 6 months. Full-Text PDF" @default.
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• W2095670555 title "Efficacy and safety of calcipotriol/betamethasone dipropionate ointment for the treatment of simple onycholysis: An open-label study" @default.
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