Ustekinumab for Rapid Treatment of Nail Psoriasis

Rallis, Εfstathios; Kintzoglou, Stephanos; Verros, Constantinos

doi:10.1001/archdermatol.2010.332

Cited by 23 publications

(13 citation statements)

References 4 publications

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“…The efficacy of ustekinumab on nail involvement in our patient also provides further confirmation to previously published case reports [21] and non-randomized studies [22,23], but the reported improvement with respect to placebo at week 12 did not reach statistical significance in Japanese patients involved in a phase II/III clinical trial [24]. …”

Section: Discussionsupporting

confidence: 91%

Ustekinumab Treatment of TNF Antagonist-Induced Paradoxical Psoriasis Flare in a Patient with Psoriatic Arthritis: Case Report and Review

Puig¹,

Morales-Múnera²,

López‐Ferrer³

et al. 2012

Dermatology

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Background: Therapy with tumour necrosis factor α (TNF) inhibitors can be associated with paradoxical reactions, namely the de novo development or flaring of conditions that usually respond to these therapeutic agents, such as arthritis, inflammatory bowel disease, sarcoidosis or psoriasis. They are considered a class effect of these drugs, and their incidence ranges from 1 to 5%, with paradoxical psoriasis (psoriasis vulgaris, palmoplantar pustulosis, scalp psoriasis and their combinations) being most frequently reported. Treatment of paradoxical psoriasis often requires withdrawal of the inducing drug and switching to another anti-TNF agent, but often this cannot avoid recurrence or persistence of the rash and/or loss of the therapeutic effect on the underlying condition. Case Report: We report on a 47-year-old woman who developed incapacitating palmoplantar pustulosis and psoriasis vulgaris flare with severe scalp and nail involvement after 5 months of treatment with adalimumab for psoriatic arthritis. Several treatments, including topical corticosteroids, photochemotherapy, ciclosporin, acitretin and etanercept 50 mg twice a day for 1 month, were ineffective or not tolerated. Treatment with ustekinumab 45 mg provided complete resolution of skin lesions with acceptable therapeutic control of the arthritis, with a follow-up duration of 16 months. Conclusion: A review of the reported cases suggests that this may be a therapeutic option in patients who develop paradoxical psoriasis while under treatment for arthritis or Crohn’s disease.

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Section: Discussionsupporting

confidence: 91%

Ustekinumab Treatment of TNF Antagonist-Induced Paradoxical Psoriasis Flare in a Patient with Psoriatic Arthritis: Case Report and Review

Puig¹,

Morales-Múnera²,

López‐Ferrer³

et al. 2012

Dermatology

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“…In another article, one patient with recalcitrant psoriasis, including psoriatic nail disease had been treated with acitretin, cyclosporine and retreated with etanercept without results. A rapid improvement of nail psoriasis was achieved after the first injection of ustekinumab 45 mg at week 4, and complete resolved at week 8 (44).…”

Section: Treatmentsmentioning

confidence: 96%

Treatment of inflammatory nail disorders

Dehesa

Tosti

2012

Dermatol Ther

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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.

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“…Ustekinumab is another biologic drug used for psoriasis by blocking the p40 subunit, which is shared by interleukins (IL)-12/23 13 . Ustekinumab also has high efficacy and safety for the treatment of nail psoriasis 14 .…”

Section: Discussionmentioning

confidence: 99%

Severe Nail Fold Psoriasis Extending from Nail Psoriasis Resolved with Ustekinumab: Suggestion of a Cytokine Overflow Theory in the Nail Unit

et al. 2016

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Because nail psoriasis is difficult to treat, therapy with many biological drugs has been attempted. Ustekinumab is approved for chronic plaque psoriasis and psoriatic arthritis (PsA), with some trials reporting nail improvement using this agent. A 51-year-old man with severe chronic plaque psoriasis had severe involvement of all fingernails and toenails, with accompanying nail fold psoriasis. He also had PsA of the small joints of the fingers. Despite multiple conventional therapies, the nail lesions did not improve, and his nail psoriasis severity index score was 97. After a fourth ustekinumab injection, most of the fingernail psoriasis was resolved, and only hyperkeratosis remained on both large toenails. Because the nail plate, nail fold, and small joints of the fingers are closely apposed structures within a small area, cytokines produced from the nail units overflow to the nail fold and small joints and can induce nail fold psoriasis and PsA.

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Ustekinumab for Rapid Treatment of Nail Psoriasis

Cited by 23 publications

References 4 publications

Ustekinumab Treatment of TNF Antagonist-Induced Paradoxical Psoriasis Flare in a Patient with Psoriatic Arthritis: Case Report and Review

Ustekinumab Treatment of TNF Antagonist-Induced Paradoxical Psoriasis Flare in a Patient with Psoriatic Arthritis: Case Report and Review

Treatment of inflammatory nail disorders

Severe Nail Fold Psoriasis Extending from Nail Psoriasis Resolved with Ustekinumab: Suggestion of a Cytokine Overflow Theory in the Nail Unit

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