Nail Psoriasis

Abstract

Nail psoriasis is common, occurring in up to half of patients with psoriasis and in 90% of patients with psoriatic arthritis. Left untreated, it may progress to debilitating nail disease, which leads to significant functional impairment. The most common clinical signs of nail psoriasis are nail plate pitting and onycholysis. Other classical signs include oil drop discoloration, subungual hyperkeratosis, and splinter hemorrhages. The modified Nail Psoriasis Severity Index (mNAPSI) can be used to grade the severity of nail psoriasis, while the Nail Psoriasis Quality of Life Scale (NPQ10) is a questionnaire that evaluates the impact of nail psoriasis on the patient's functional status and quality of life. Treatment of nail psoriasis should be individualized according to the patient's preferences, severity of nail changes, and presence of skin and/or joint involvement. Both topical and intralesional therapies are safe and effective treatment modalities for nail disease, but are limited by poor adherence and pain, respectively. Systemic therapy such as oral retinoids may be considered for widespread nail disease causing significant morbidity. Among biologic agents, tumor necrosis factor-α inhibitors and T-cell-targeted therapies such as ustekinumab may be useful for refractory severe nail psoriasis.

Photodynamic Therapy and Skin Appendage Disorders: A Review

“…Treatment of nail psoriasis is disappointing, with only 19.3% of patients showing marked improvement during any topical treatment. In addition, 77% would like to receive a more effective therapy for their nails [80,82] . Traditional topical and systemic treatments are sometimes ineffective for these two conditions.…”

Mottled Lunulae in Nail Psoriasis: Report of Three Cases

“…Frequently, more than one nail is involved and the fingernails are affected more often than the toenails [3,4] . These findings can be helpful for the diagnosis and some of them, for example hyponychial dilated capillaries, can correlate with disease severity and with response to treatment [2] .…”

“…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.…”

Clinical Manifestations and Management Considerations of Psoriasis Affecting The Nail Unit

“…[8][9] However, it should be considered a last resort due to the potential associated complications, particularly when biopsy of the matrix is needed. In a study of 22 nail psoriasis patients who underwent nail biopsy, a definitive diagnosis of psoriasis was possible in only 55% of cases.…”

“…6,7 Isolated nail psoriasis is present in 5-10% of patients. 8,9 Though the degree of nail involvement and types of nail changes present varies among patients, in many cases, nail psoriasis can cause disability by compromising the normal structure and function of the nail. A healthy fingernail, not only protects the distal digits, but is crucial for the fine sensory capabilities and manual dexterity of the fingertips via transference of opposing pressure to the palmar surface of the dorsal phalanx.…”