Nail psoriasis is often found in patients with plaque psoriasis and can greatly impact quality of life. This is particularly true in more severe cases, as it affects the structure and function of the patient's nail. Treatment for nail psoriasis is often challenging, involving topical medications, injections, and systematic therapies. This article aims to give an overview of the varied clinical presentations of nail psoriasis and the current treatments available for patients with this condition. Risks and efficacies of these treatments will be evaluated to determine the best treatment protocols.
GudjónssonJ.E.KárasonA.AntonsdóttirA.A.HLA-Cw6-positive and HLA-Cw6-negative patients with psoriasis vulgaris have distinct clinical features.J Invest Dermatol.2002; 118(2): 362–365.
2.
ZhuK.J.LvY.M.YinX.Y.Psoriasis regression analytics of MHC loci identifies shared genetic variants with vitiligo.PLoS ONE.2011; 6(11): e23089.
3.
McGonagleD.TanA.L.BenjaminM.. The biomechanical link between skin and joint disease in psoriasis and psoriatic arthritis: What every dermatologist needs to know.Ann Rheum Dis.2008; 67: 1–4.
4.
ElderJ.T.. Genome-wide association scan yields new insights into the immunopathogenesis of psoriasis.Genes Immun.2009; 10: 201–209.
5.
Di ChiacchioN.AndréJ.HanekeE.Di ChiacchioN.G.NoriegaL.F.Ocampo-GarzaJ.. Pseudo-pitting of the nail in psoriasis.J Eur Acad Dermatol Venereol.2017; 31(7): e347–e348.
6.
DograA.AroraA.K.. Nail Psoriasis: The Journey So Far.Indian J Dermatol.2014; 59(4): 319–333.
7.
LebwohlM.. Oil Spot and Onycholysis [photograph].New York (NY): Mount Sinai Department of Dermatology; 2017. 1 photograph, color.
8.
LebwohlM.. Leukonychia [photograph].New York (NY): Mount Sinai Department of Dermatology; 2017. 1 photograph, color.
9.
RichP.ScherR.K.. Nail Psoriasis Severity Index: a useful tool for evaluation of nail psoriasis.J Am Acad Dermatol.2003; 49(2): 206.
10.
van der VeldenH.M.KlaassenK.van der KerkhofP.PaschM.. Fingernail psoriasis reconsidered: A case-control study.J Am Acad Dermatol.2013; 69(2): 245–252.
11.
KlaassenK.M.Van de KerkhofP.C.BastiaensM.T.PlusjéL.G.BaranR.L.PaschM.C.. Scoring Nail Psoriasis.J Am Acad Dermatol.2014; 70(6): 1061–1066.
12.
AugustinM.BlomeC.CostanzoA.Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA): development and validation of a tool for assessment of nail psoriasis outcomes.Br J Dermatol.2014; 170(3): 591–598.
13.
HashimotoY.UyamaM.TakadaY.YoshidaK.IshikoA.. Dermoscopic features of nail psoriasis treated with biologics.J Dermatol.2017; 44(5): 538–541.
14.
MarinaM.E.SolomonC.BolboacaS.D.BocsaC.MihuC.M.TâtaruA.D.. High-frequency sonography in the evaluation of nail psoriasis.Med Ultrason.2016; 18(3): 312–317.
15.
NatarajanV.NathA.K.ThappaD.M.SinghR.VermaS.K.. Coexistence of onychomycosis in psoriatic nails: A descriptive study.Indian J Dermatol Venereol Leprol.2010; 76(6): 723.
16.
NakamuraR.C.AbreuLdDuque-EstradaB.TamlerC.LeveroneA.P.. Comparison of nail lacquer clobetasol efficacy at 0.05%, 1% and 8% in nail psoriasis treatment: prospective, controlled and randomized pilot study.An Bras Dermatol.2012; 87(2): 203–211.
17.
BasukP.ScherR.RicciA.. Dermatologic Diseases of the Nail Unit. Nails: therapy, diagnosis, surgery.W.B. Saunders, Philadelphia; 1990: 127–133.
18.
ScherR.K.StillerM.ZhuY.I.. Tazarotene 0.1% gel in the treatment of fingernail psoriasis: a double-blind, randomized, vehicle-controlled study.Cutis.2001; 68(5): 355–358.
19.
DiluvioL.CampioneE.PaternòE.J.MordentiC.El HachemM.ChimentiS.. Childhood nail psoriasis: a useful treatment with tazarotene 0.05%Pediatr Dermatol.2007; 24(3): 332–333.
20.
HeckerD.WorsleyJ.YuehG.KurodaK.LebwohlM.. Interactions between tazarotene and ultraviolet light.J Am Acad Dermatol.1999; 41(6): 927–930.
21.
JoshiM.SharmaV.PathakK.. Matrix based system of Isotretinoin as nail lacquer to enhance transungal delivery across human nail plate.Int J Pharm.2015; 478(1): 268–277.
22.
AustadJ.BjerkeJ.R.GjertsenB.T.Clobestal propionate followed by calcipotriol is superior to calcipotriol alone in topical treatment of psoriasis.J Eur Acad Dermatol Venereol.1998 Jul; 11(1): 19–24.
23.
KatohN.KishimotoS.. Combination of calcipotriol and clobetasol propionate as a premixed ointment for the treatment of psoriasis.Eur J Dermatol.2003; 13(4): 382.
24.
Sánchez RegañaM.Márquez BalbásG.Umbert MilletP.. Nail psoriasis: a combined treatment with 8% clobetasol nail lacquer and tacalcitol ointment.J J Eur Acad Dermatol Venereol.2008; 22(8): 963–969.
25.
de JongE.M.MenkeH.E.van PraagM.C.van De KerkhofP.C.. Dystrophic psoriatic fingernails treated with 1% 5-fluorouracil in a nail penetration-enhancing vehicle: a double-blind study.Dermatology (Basel).1999; 199(4): 313–318.
26.
SternD.K.CreaseyA.A.QuijijeJ.LebwohlM.G.. UV-A and UV-B penetration of normal human cadaveric fingernail plate.Arch Dermatol.2011; 147(4): 439–441.
27.
HuangY.C.ChouC.L.ChiangY.Y.. Efficacy of pulsed dye laser plus topical tazarotene versus topical tazarotene alone in psoriatic nail disease: a single-blind, intrapatient left-to-right controlled study.Lasers Surg Med.2013; 45(2): 102–107.
28.
Arango-DuqueL.C.Roncero-RiescoM.Usero BárcenaT.PalaciosÁlvarezI.Fernández LópezE.. Treatment of nail psoriasis with Pulse Dye Laser plus calcipotriol betametasona gel vs. Nd: YAG plus calcipotriol betamethasone gel: An intrapatient left-to-right controlled study.Actas Dermosifiliogr.2017; 108(2): 140–144.
29.
LeeJ.Y.. Severe 20-nail psoriasis successfully treated by low dose methotrexate.Dermatol Online J.2009; 15(11): 8.
30.
SaricaogluH.OzA.TuranH.. Nail Psoriasis Successfully Treated with Intralesional Methotrexate: case report.Dermatology (Basel).2011; 222(1): 5–7.
31.
Sánchez-RegañaM.Sola-OrtigosaJ.Alsina-GibertM.Vidal-FernándezM.Umbert-MilletP.. Nail psoriasis: a retrospective study on the effectiveness of systemic treatments (classical and biological therapy).J Eur Acad Dermatol Venereol.2011; 25(5): 579–586.
32.
PappK.ReichK.LeonardiC.L.Apremilast, an oral phosphodiesterase 4 (PDE4) inhibitor, in patients with moderate to severe plaque psoriasis: results of a phase III, randomized, controlled trial (efficacy and safety trial evaluating the effects of apremilast in psoriasis [ESTEEM] 1).J Am Acad Dermatol.2015; 73(1): 37–49.
33.
RichP.GooderhamM.BachelezH.Apremilast, an oral phosphodiesterase 4 inhibitor, in patients with difficult-to-treat nail and scalp psoriasis: results of 2 phase III randomized, controlled trials (ESTEEM 1 and ESTEEM 2).J Am Acad Dermatol.2016; 74(1): 134–142.
34.
ZabaL.C.CardinaleI.GilleaudeauP.Amelioration of epidermal hyperplasia by TNF inhibition is associated with reduced Th17 responses.J Exp Med.2007; 204(13): 3183–3194.
35.
SaracenoR.PietroleonardoL.MazzottaA.ZangrilliA.BianchiL.ChimentiS.. TNF-α antagonists and nail psoriasis: an open, 24-week, prospective cohort study in adult patients with psoriasis.Expert Opin Biol Ther.2013; 13(4): 469–473.
36.
BarduzziF.LambertiM.ChessaM.A.MagnanoM.PatriziA.PiracciniB.M.. Nail involvement as a negative prognostic factor in biological therapy for psoriasis: a retrospective study.J Eur Acad Dermatol Venereol.2017; 31(5): 843–846.
37.
ElewskiB.RichP.OkunM.PappK.BakerC.CrowleyJ.. Adalimumab for Nail Psoriasis: Efficacy and Safety from the First 26 Weeks of a Phase-3, Randomized, Placebo-Controlled Trial. Poster presented at 5th Congress of the Psoriasis International Network (Psoriasis 2016). July 7-9, 2016.
38.
RichP.BourcierM.SofenH.Ustekinumab improves nail disease in patients with moderate-to-severe psoriasis: results from PHOENIX 1.Br J Dermatol.2014; 170(2): 398–407.
39.
PaulC.ReichK.GottliebA.B.Secukinumab improves hand, foot and nail lesions in moderate-to-severe plaque psoriasis: subanalysis of a randomized, double-blind, placebo-controlled, regimen-finding phase 2 trial.J Eur Acad Dermatol Venereol.2014; 28(12): 1670–1675.
40.
DennehyE.B.ZhangL.AmatoD.GoldblumO.RichP.. Ixekizumab Is Effective in Subjects With Moderate to Severe Plaque Psoriasis With Significant Nail Involvement: Results From UNCOVER 3.J Drugs Dermatol.2016; 15(8): 958–961.
41.
ChandrakumarS.F.YeungJ.. Interleukin-17 antagonists in the treatment of psoriasis.J Cutan Med Surg.2015; 19(2): 109–114.
42.
PaschM.C.. Nail Psoriasis: A Review of Treatment Options.Drugs.2016; 76(6): 675–705.
43.
GaspariA.A.TyringS.. New and emerging biologic therapies for moderate-to-severe plaque psoriasis: mechanistic rationales and recent clinical data for IL-17 and IL-23 inhibitors.Dermatol Ther.2015; 28(4): 179–193.
44.
Van den BoschF.MangerB.GoupilleP.Effectiveness of adalimumab in treating patients with active psoriatic arthritis and predictors of good clinical responses for arthritis, skin and nail lesions.Ann Rheum Dis.2010; 69(2): 394–399.
45.
RudwaleitM.Van den BoschF.KronM.KaryS.KupperH.. Effectiveness and safety of adalimumab in patients with ankylosing spondylitis or psoriatic arthritis and history of anti-tumor necrosis factor therapy.Arthritis Res Ther.2010; 12(3): R117.
46.
ThaçiD.UnnebrinkK.SundaramM.SoodS.YamaguchiY.. Alalimumab for the treatment of moderate to severe psoriasis: subanalysis of effects on scalp and nails in the BELIEVE study.J Eur Acad Dermatol Venereol.2015; 29(2): 353–360.
47.
KhobzeyK.LiskovaI.SzegediA.Effectiveness of adalimumab in the treatment of scalp and nail affection in patients with moderate to severe plaque psoriasis in routine clinical practice.Acta Dermatovenerol APA.2017; 26(1): 11–14.
48.
OrtonneJ.P.PaulC.BerardescaE.A 24-week randomized clinical trial investigating the efficacy and safety of two doses of etanercept in nail psoriasis.Br J Dermatol.2013; 168(5): 1080–1087.
49.
Al-MutairiN.NourT.Al-RqobahD.. Onychomycosis in patients of nail psoriasis on biologic therapy: a randomized, prospective open label study comparing Etanercept, Infliximab and Adalimumab.Expert Opin Biol Ther.2013; 13(5): 625–629.
50.
FabroniC.GoriA.TroianoM.PrignanoF.LottiT.. Infliximab efficacy in nail psoriasis. A retrospective study in 48 patients.J Eur Acad Dermatol Venereol.2011; 25(5): 549–553.
51.
LangleyR.G.RichP.MenterA.Improvement of scalp and nail lesions with ixekizumab in a phase 2 trial in patients with chronic plaque psoriasis.J Eur Acad Dermatol Venereol.2015; 29(9): 1763–1770.
52.
Van de KerkhofP.GuentherL.GottliebA.B.Ixekizumab treatment improves fingernail psoriasis in patients with moderate-to-severe psoriasis: results from the randomized, controlled and open-label phases of UNCOVER-3.J Eur Acad Dermatol Venereol.2017; 31(3): 477–482.
53.
Antúnez-LayA.CabroilerJ.Andino-NavarreteR.. Are biologics useful for nail psoriasis?Medwave.2016; 16(11): e6363.
54.
CrowleyJ.J.WeinbergJ.M.WuJ.J.RobertsonA.D.Van VoorheesA.S.. Treatment of nail psoriasis: best practice recommendations from the Medical Board of the National Psoriasis Foundation.JAMA Dermatol.2015; 151(1): 87–94.
