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Efficacy of Fluocinonide\Bifonazole cream for the treatment of trachyonychia: A retrospective case series
Avner Shemer1, Ralph Daniel2, Riad Kassem1, Nechama Sharon3, Renata Farhi4, Baruch Kaplan5, Vered Hermush6, Eran Galili1
1 Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
2 University of Mississippi Medical Center, Jackson, Mississippi; University of Alabama, Birmingham, Alabama, USA
3 Department of Pediatric Hemato-Oncology, Laniado Hospital, Netanya; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
4 Hospital Nossa Senhora da Saude, University Fundação Tecnico Educacional Souza Marques, Rio De Janeiro, Brazil
5 Adelson School of Medicine, Ariel University, Ariel, Israel
6 Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa; Department of Geriatrics and Skilled Nursing, Laniado Medical Center, Netanya, Israel
Correspondence Address:
Eran Galili
Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat Gan
Israel
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijd.ijd_1088_21
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Background: Trachyonychia is a benign nail condition, most commonly seen in children. Trachyonychia manifests as excessive longitudinal ridging, nail roughness, and nail brittleness. Treatment is sought mainly for esthetic reasons as well as functional reasons. A number of therapeutic approaches exist, mainly based on case reports or small non-comparative case series. Aims: To report treatment outcome among patients with trachyonychia. Methods: A retrospective case-series study was conducted among patients who were treated trachyonychia between years 2017 and 2020. Patients were prescribed fluocinonide 0.05% with bifonazole 1% cream, applied with or without occlusion, and methylprednisolone 1–2 mg/nail, injected into the involved nail matrix, or oral cyclosporine 3 mg/kg. Complete response (over 90% improvement) and partial response (over 50% improvement) were assessed. Results: A total of 43 patients with trachyonychia were included [mean age 10.0 years (±5.7), 69.8% males, mean disease duration 4.7 years (±3.0)]. In 90.7% of the cases, topical fluocinonide\bifonazole cream was prescribed. Under-occlusion topical application was found to be highly effective, achieving complete response in 35.3% and partial response in an additional 52.9% of the patients. Occluded application was also found to be significantly more effective than non-occluded application. Treatment efficacy was not affected by the severity of nail roughness, trachyonychia morphology, or whether trachyonychia was idiopathic or coexisted with other dermatological conditions. Conclusion: Occluded application of fluocinonide plus bifonazole cream is efficient for the treatment of trachyonychia and should be considered a first line of treatment.
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