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. 2013 Jan 31;2013(1):CD007633. doi: 10.1002/14651858.CD007633.pub2

Kwang 1995.

Methods This was a randomised, internally placebo‐controlled study.
Blinding was unclear.
It was unclear if intention‐to‐treat analysis was conducted.
Participants Inclusion criteria of the trial
  • 12 participants with symmetrical nail psoriasis were enrolled in the study.

Interventions
  • Active treatment was randomly allocated to the affected nails of 1 hand, while the other 1 served as control.


The nails and nailbeds were treated with an electron beam (7 mega electron volts). A total of 6 Gy was given in 8 fractions over 8 weeks (1 fraction of 0.75 per week).
Follow‐up assessment was performed 3, 6, and 12 months after treatment.
Outcomes Outcomes of the trial
  1. Photographs of the involved nails of both hands were obtained prior to electron beam therapy and at each follow‐up visit. Each of the nails were graded as follows: grade 1: pits, furrows, transverse depressions, onycholysis; grade 2: subungual hyperkeratosis, thickening and crumbling of nail plate, oil drop, discolourations, and splinter haemorrhages; and grade 3: proximal nail fold involvement, distal arthropathy.

  2. At each follow up, the nails were graded and scored as follows: cured without residual nail abnormalities, markedly improved with residual lesions, moderately improved, slightly improved, and no change.

Notes None of the participants received systemic treatment and did not apply any topical medication or clip their nail while on follow up.
The only local side‐effect was a temporary deep brownish‐black discolouration of all the electron beam‐treated nails.
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Quote: "Active treatment was randomly allocated to the affected nails of one hand, while the other one served as control."
Comment: This was probably done.
Allocation concealment (selection bias) Unclear risk Comment: The paper provided insufficient details.
Blinding (performance bias and detection bias) 
 Clinician/ Investigator Unclear risk Comment: There was no information about blinding of the clinician.
Blinding (performance bias and detection bias) 
 Participants Unclear risk Comment: There was no information about blinding of the participants.
Blinding (performance bias and detection bias) 
 Outcome assessor Unclear risk Comment: There was no information about blinding of the outcome assessor.
Incomplete outcome data (attrition bias) 
 All outcomes Low risk There were no missing outcome data.
Selective reporting (reporting bias) Low risk All of the expected outcomes were reported
Other bias Unclear risk There was no information about the baseline characteristics.