Nail psoriasis: a retrospective study on the effectiveness of systemic treatments (classical and biological therapy)

Abstract

The response to treatment is slower in the nail lesions than in the skin lesions. The improvement of nail psoriasis is significant both with the classical treatments significantly higher in cyclosporin; and biological treatment (infliximab and adalimumab at 12 and 24 weeks).

Nail psoriasis: The journey so far

“…[88] In another study, MTX produced NAPSI score improvements of 7%, 31%, and 35%, respectively, after 12, 24, and 48 weeks (4). [89] A single-blinded, randomized study involving 34 patients also showed that MTX achieved a 43% decrease in NAPSI scores, compared with a 37% reduction for cyclosporine (1b). [90] In this study, it was also seen that the nail matrix lesions did better with MTX, whereas nail bed psoriasis fared better with cyclosporine.…”

“…[93] In a retrospective evaluation, cyclosporine was found to improve the NAPSI score after 12, 24, and 48 weeks by 40%, 72%, and 89%, respectively. [89] In a single blind study of 54 patients, oral cyclosporine (3-4.5 mg/kg/day) with and without topical calcipotriol (50 μg/g) twice daily was used for 3 months. Subungual hyperkeratosis, onycholysis, and pitting improved in 79% of patients in the combination group compared with only 47.6% of those given oral cyclosporine alone (3).…”

Nail Disorders Due to Dermatological Diseases

“…Choice of therapy depends on age, association of nail psoriasis with skin and joint psoriasis, number of nails involved, and severity of the signs [ 3 ]. In the nails, as in the skin, psoriasis has a chronic course, and treatment should be changed in time in order to induce remission and maintain it, with the lower risk or side effects.…”

What′s new in nail disorders?

“…Also, the treatment response of nail psoriasis is slow and incomplete. Sanchez-Regana et al [61] retrospectively reviewed the data of 84 psoriasis patients who had received classical systemic therapy (acitretin, methotrexate, cyclosporin, photo (chemo) therapy) or biologics (infliximab, efalizumab, etanercept, adalimumab) for moderate to severe skin disease or psoriatic arthritis and had concomitant significant nail involvement. The author found that the NAPSI score fell significantly with all classical treatments (except NBUVB) as well as with the biological treatments.…”