Interventions for nail psoriasis

Abstract

Infliximab, golimumab, SRT, grenz rays, and electron beam caused significant nail improvement compared to the comparative treatment. Although the quality of trials was generally poor, this review may have some implications for clinical practice.Although powerful systemic treatments have been shown to be beneficial, they may have serious adverse effects. So they are not a realistic option for people troubled with nail psoriasis, unless the patient is prescribed these systemic treatments because of cutaneous psoriasis or psoriatic arthritis or the nail psoriasis is severe, refractory to other treatments, or has a major impact on the person's quality of life. Because of their design and timescale, RCTs generally do not pick up serious side-effects. This review reported only mild adverse effects, recorded mainly for systemic treatments. Radiotherapy for psoriasis is not used in common practice. The evidence for the use of topical treatments is inconclusive and of poor quality; however, this does not imply that they do not work.Future trials need to be rigorous in design, with adequate reporting. Trials should correctly describe the participants' characteristics and diagnostic features, use standard validated nail scores and participant-reported outcomes, be long enough to report efficacy and safety, and include details of effects on nail features.

Psoriatic Arthritis and Burden of Disease: Patient Perspectives from the Population-Based Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) Survey

“…Approximately twice as many patients with PsA (21%) had nail involvement compared with patients with psoriasis alone (11%), and 44% of patients with PsA reported scalp involvement; however, overall these rates are lower than those previously reported [8,17,18,21,26]. The presence of skin disease in these areas has been found to have a disproportionate effect on QoL and is often difficult to treat, with limited effective treatment options [7,9,19,21].…”

Mottled Lunulae in Nail Psoriasis: Report of Three Cases

“…Topical modalities include corticosteroids under occlusion with or without keratolytics, intralesional corticosteroids, vitamin D derivatives under occlusion, or topical PUVA. Systemic treatments proven useful are acitretin, methotrexate, cyclosporine, and biologic agents [3,4,9] . Our 3 patients were treated with topical calcipotriol/betamethasone under occlusion and 1 of them received one intralesional corticosteroid injection with improvement of the nail dystrophy and reduction of the red points.…”

Ungueal Psoriasis: A Single Nail Affected

“…Nail disease is usually overlooked in the management of psoriasis, with skin involvement being the primary concern. Also, treatment of nail psoriasis is a big challenge for a dermatologist for some many reasons like: the poor drug delivery, a long duration of treatment required because of the slow rate of nail growth and very important the faults in the diagnosis [5].…”