Despite several treatment modalities, nail psoriasis is still a challenging therapeutic issue for dermatologists. Topical and intralesional steroid injections are widely used to treat psoriatic nails. Both options have shown to be beneficial for psoriatic nails with minimal or no cutaneous psoriasis. Intralesional steroid injections should be used as first-line treatment in adult patients with nail psoriasis involving just the nail matrix. On the other hand, a topical corticosteroid and vitamin D combination is the most recommended therapy for nail bed psoriasis. However, comparative studies on these therapeutic options still lack. This is a prospective pilot study that desired to study the effectiveness of intralesional triamcinolone acetonide (TA) injection and topical betamethasone/calcipotriol treatment in nail psoriasis and compare the 8 and 16-week efficacy of the treatments. There were 4 psoriasis patients with nail dystrophy who participated in the study. Each patient with 2 selected psoriatic nails was enrolled in the study (total nails = 8). The nails must have the target NAPSI score of at least 3 points. The two nails of each patient were given different treatments which were separated into group A and group B. Group-A nails received intralesional TA (10 mg/ml) injections at the 0 and 8 weeks. Group-B nails were instructed to use topical betamethasone/calcipotriol once daily for 4 months. The participants were followed up every 8 weeks to assess the target Nail Psoriasis Severity Index (target NAPSI) score and side effects. All participants were followed up for 16 weeks. At the end of the study, the mean target NAPSI score was improved by around 50% and 40% in group A and group B, respectively.  Nail matrix showed more improvement than nail bed by both methods. Although, there were no significant differences in NAPSI score reduction between both treatment modalities (P>0.05), the percent improvement of the total score, matrix, and nail bed of group A were all greater than group B’s score. There were no adverse events during 16 weeks except the pain while the injection process. Intralesional TA injection seems to be more effective in treating psoriatic nails than topical betamethasone/calcipotriol treatment. The injection group also shows greater efficacy in both matrix and nail bed psoriasis than topical therapy.