BACKGROUND: Superficial nail abnormalities include conditions which produce nail surface changes such as trachyonychia, pitting and ridging. Mostly, this is a neglected area due to the dearth of treatment options. Glycolic acid peeling has been reported to be effective in such cases.
OBJECTIVE: This study aims to assess the safety and efficacy of medium depth peels (70% glycolic acid versus phenol combination peel [8% phenol with 15% trichloroacetic acid]) in patients with superficial nail abnormalities.
METHODS: A right-left comparative study in patients with superficial nail abnormalities was done. On the right finger or toenails phenol combination peels and on the left side 70% glycolic acid was used in a predefined protocol over 12 weeks. The severity was assessed objectively by a new devised index (Nail Surface abnormality Index (NSI]). Patient\'s subjective perception of severity was assessed by Visual Analogue Scale (VAS), and that of the physician was assessed by Physician\'s Global Assessment (PGA) scores.
RESULTS: A total of 17 patients were enrolled, two dropped out and 15 patients were included in the final analysis (mean age 19.2 years, total 120 nails treated). The mean NSI score declined from 7.88 ± 0.45 to 4.02 ± 0.45 on the right side; and from 8.0 ± 0.45 to 4.32 ± 0.44 on left side, at the end of 12 weeks. The VAS declined from 6.57 ± 0.26 to 3.87 ± 0.33 on right side and from 6.32 ± 0.28 to 3.78 ± 0.32 on left side. According to PGA score, five patients showed good improvement, seven showed moderate improvement and three responded poorly.
CONCLUSIONS: Both the medium depth peels were found to be safe and equally efficacious modalities for treatment of superficial nail abnormalities.

BACKGROUND: Despite efforts to treat trachyonychia, there is no promising treatment modality.
OBJECTIVE: This study evaluated the efficacy and safety of calcipotriol plus betamethasone dipropionate ointment on trachyonychia.
METHODS: A total of 39 patients with 432 nails affected by trachyonychia were enrolled. All patients applied calcipotriol/betamethasone ointment once daily without occlusion for 6 months. Outcome measures were assessed by physician\'s global assessment (degree of roughness: 0, clear; 1, mild; 2, moderate; 3, marked; 4, severe) at all time points.
RESULTS: After 6 months of therapy, 98.6% (426/432) of nails showed significant clinical improvement; 4.2% were completely free from nail lesions. The mean physician global assessment score decreased significantly from 3.5 to 1.7 points (p< 0.05). No serious side effects were reported, except mild pruritus and erythema in 2 patients.
CONCLUSIONS: This is the first study to prospectively evaluate the efficacy and safety of calcipotriol/betamethasone ointment for the treatment of trachyonychia. The results indicate topical calcipotriol/betamethasone is an effective and safe treatment for symptom improvement of trachyonychia.

BACKGROUND: Nail lichen planus (NLP) occurs in 10% of patients with disseminated disease but it can also occur in isolation. The outcome of treatment is usually disappointing and data about its long-term prognosis are lacking.
OBJECTIVE: To study clinical features, response to treatment and follow-up of a series of 20 patients with NLP.
METHODS: A descriptive study was conducted of 20 patients with histologically confirmed NLP seen at consultations for nail disorders between September 2009 and April 2013.
RESULTS: The mean age was 35 years (9-56 years) with no gender preponderance. Forty percent of patients were children. Stress was an evident triggering factor in 20% of patients. The mean duration was around 48 months (2 months to 10 years). Only 25% of patients had extra-ungual lesions. All 20 nails were affected in 55% of patients. Nail matrix involvement was observed in 85% of cases and 55% had nail-bed involvement. Twenty-five percent of patients were presenting severe involvement such as pterygium or anonychia. Intramuscular corticosteroids were given to 10 patients. In 80% of patients, the NLP was limited or regressed rapidly from the third injection. The average follow-up was 24 months.
CONCLUSIONS: Our study highlights the frequency of paediatric forms and of often aesthetically unacceptable nail scarring. Early diagnosis of NLP, notably in children, would allow initiation of adequate treatment that could perhaps limit the risk of such sequelae.