Nail Psoriasis: a Review of Current Topical and Systemic Therapies
Caitlin Kennedy Carney, MD, Wendy Cantrell, CRNP, and Boni E Elewski, MD
Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, USA.
Psoriasis is a chronic inflammatory skin disorder that affects millions of patients worldwide. Nail psoriasis will affect 80–90% of patients with psoriasis at some point in their lifetime. Nail dystrophies that are commonly associated with psoriasis include subungual hyperkeratosis, nail plate crumbling, splinter hemorrhages, lunula erythema, leukonychia, and paronychia. There are few randomized, controlled trials that have looked at the safety and efficacy of nail psoriasis treatments; therefore, no particular treatment algorithm has been advocated. In general, topical therapy is appropriate when nail disease exists alone or with mild skin disease. Intralesional therapy is indicated for difficult-to-treat nail disease or when one nail needs aggressive therapy. Systemic therapy is indicated when joint and skin disease warrant systemic treatment, or when nail disease causes significant disruption to quality of life. Biological therapies offer rapid and sustained clearing of nail lesions to the same degree with which they clear the skin.