Treatment of inflammatory nail disorders

Abstract

This article provides an updated review on diagnosis and treatment of inflammatory nail disorders including psoriasis, lichen planus, trachyonychia, and autoimmune bullous disorders. Despite the significant negative repercussion of the nail psoriasis in the quality of life of patients, treatment is often not sufficiently effective. The efficacy of topical therapies is limited to nail bed psoriasis. Intralesional corticosteroid injections are extensively utilized in nail matrix psoriasis. Systemic immunosuppressant drugs such as methotrexate and cyclosporine have shown efficacy. Biologics, particularly infliximab and etanercept, have also demonstrated high efficacy in the treatment of severe nail disease. Nail matrix lichen planus can cause nail atrophy and irreversible nail scarring and requires prompt treatment with systemic steroids. There is not gold standard therapy for trachyonychia, but in most cases the nail signs improve spontaneously and treatment is not necessary. Nail changes in pemphigus and other autoimmune disorders respond promptly to systemic therapy with steroids and immunosuppressants.

Treatment of Nail Psoriasis: Common Concepts and New Trends

“…Various topical treatment modalities have been used in nail psoriasis including corticosteroids, dithranol, fluorouracil, vitamin D 3 analogues, tacrolimus, cyclosporine, and tazarotene [1, 4, 7, 8] (Table 1). …”

“…It is slightly more common in male patients than females [3, 6]. Nail psoriasis leads to considerable impairment in quality of life due to aesthetic concerns and more importantly limitations in daily activities resulting from the associated pain [2, 7]. …”

Lichen planus and lichenoid reactions as a systemic disease

“…Nail LP can affect only one nail but usually affects several or most nails (16). Fingernails are more frequently involved than toenails (16). Clinically, the involved nails show longitudinal ridging and splitting (onychoschizia), longitudinal striation (onychorrhexis), nail absence (anonychia), subungual hyperkeratosis, and thinning nail plate (2)( Figure 5).…”

“…Nail LP can affect only one nail but usually affects several or most nails (16). Fingernails are more frequently involved than toenails (16).…”

“…Most nail changes result from involvement of the nail matrix (2). LP of the nail bed causes onycholysis, and subungual hyperkeratosis and may be very difficult to distinguish from nail psoriasis or onychomycosis (16).…”