Nail psoriasis – a treatment challenge

Radtke, Marc Alexander; Beikert, Florian C.; Augustin, Matthias

doi:10.1111/ddg.12054

Cited by 27 publications

(39 citation statements)

References 65 publications

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“…The differential diagnosis includes: OM [ 2 ] , a foreign body [ 4 ] , a malignant tumor of the nail unit [ 5 ] , severe nail psoriasis with onychodystrophy [ 6 ] , or onychomycosis alone [ 7,8 ] . In our case, onychomycosis was considered as a superinfection of an underlying nail tumor, which was suspected on the basis of the anamnestic, clinical and dermatoscopic fi ndings.…”

Section: Discussionmentioning

confidence: 99%

Pachyonychia of the toenail in a child

Barisani

Piraccini

Vincenzi

et al. 2018

J Deutsche Derma Gesell

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Section: Discussionmentioning

confidence: 99%

Pachyonychia of the toenail in a child

Barisani

Piraccini

Vincenzi

et al. 2018

J Deutsche Derma Gesell

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“…Concomitant skin or scalp psoriasis, or psoriatic arthritis (PsA) can occur with nail psoriasis . Approximately half of patients with skin psoriasis can have nail involvement, and approximately 80% of patients with both psoriasis and PsA also have nail involvement . Longer‐term nail disease may precede more severe psoriasis or PsA .…”

Section: Introductionmentioning

confidence: 99%

Adalimumab for nail psoriasis: efficacy and safety over 52 weeks from a phase‐3, randomized, placebo‐controlled trial

Elewski

Baker

Crowley

et al. 2019

Acad Dermatol Venereol

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BackgroundFew clinical trials have evaluated long‐term treatment of nail psoriasis with biologics.ObjectiveSafety and efficacy of adalimumab [ADA; Humira AbbVie Inc, North Chicago, IL, USA)] long‐term treatment (52 weeks) was evaluated in a phase‐3, randomized trial in patients with moderate‐to‐severe plaque psoriasis and concomitant moderate‐to‐severe fingernail psoriasis. Results from the first 26 weeks (Period A) have been reported.MethodsPatients receiving 40 mg ADA every other week or placebo in Period A, continued with or switched to 40 mg ADA every‐other‐week treatment in the subsequent 26‐week open‐label extension (OLE) period. Main efficacy evaluations were ≥75% improvement in total‐fingernail modified Nail Psoriasis Severity Index (mNAPSI 75) and achievement of Physician's Global Assessment for Fingernail Psoriasis of clear or minimal disease (PGA‐F 0/1) with a ≥2‐grade improvement from baseline, across the trial for patients who continued ADA from Period A through the OLE (Continuous‐ADA Population). Safety was evaluated during the OLE and for patients receiving ADA at any time during the study (All‐ADA Population).ResultsOf the 217 patients initially randomized in Period A, 188 (86.6%; 94 in each treatment group) entered the OLE after completion of or early escape from Period A. For the Continuous‐ADA Population (N = 109), endpoint achievement rates improved from OLE entry (Week 26) to Week 52, including total‐fingernail mNAPSI 75 (47.4–54.5%); PGA‐F 0/1 (51.1–55.6%) and total‐fingernail mNAPSI = 0 (6.6–17.9%). Serious adverse event and serious infection rates for the All‐ADA Population (N = 203) were 6.9% and 3.4%, respectively.ConclusionsIn this population of psoriasis patients with concomitant, moderate‐to‐severe nail psoriasis, long‐term efficacy and improvement in signs and symptoms of nail disease were demonstrated after every‐other‐week ADA treatment, including incremental improvements in rate of total clearance of nail disease. No new safety risks were identified for patients receiving at least one ADA dose across 52 weeks.

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“…Both scalp and nail psoriasis lesions are traditionally difficult to treat effectively with topical medications, phototherapy and even systemic oral medications . For nail psoriasis, this could be due, at least in part, to the limited flux of topically applied drugs through the nail plate and therewith a slower response time, which may lead to poor adherence . Treatment of scalp psoriasis is also difficult with poor adherence to therapy .…”

Section: Introductionmentioning

confidence: 99%