Nail disease affects most patients with psoriasis and has a substantial medical and psychological impact on the lives of those affected. Frequently, nail psoriasis is associated with severe pain, restriction in daily activity, and emotional agony that require the dermatologist to know the most up-to-date therapies. Unfortunately, no single treatment is paramount, and the choice of therapy must be individualized to disease severity, patient tolerability, cost, and risk of adverse events. Some clinical manifestations include nail pitting, discoloration, onycholysis, subungual hyperkeratosis, and splinter hemorrhages. Currently, no standardized therapeutic regimen exists; and, given the variability in clinical manifestations, multiple modalities may be needed for adequate results. More recently added to the armamentarium of topical and injectable therapies for nail disease are systemic agents, such as biologics, and photochemotherapeutic treatments. These therapies have been used with varying degrees of success. This review highlights the current treatments available for the treatment of nail psoriatic disease.
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