When addressing nail psoriasis, a first step is to distinguish the origin of the different nail changes as these can influence the choice of treatment [1]. One should recognise that onycholysis, hyperkeratosis, and discolouration emerge from the nail bed, whereas pitting originates from the nail matrix. Another important consideration is the link between nail psoriasis and psoriatic arthritis. “There is an anatomical association between the nail matrix and the distal interphalangeal joints, which means if there is inflammation in the joints, the nail matrix may be involved and vice versa,” Prof. Peter van de Kerkhof (Radboud University Medical Center, the Netherlands) pointed out. He further indicated that patients with nail psoriasis have a 3-fold risk to develop psoriatic arthritis and thus nail psoriasis might be seen as a biomarker for increased risk to develop psoriatic arthritis [1,2].
There are various topical treatment options for nail psoriasis that are likely more efficacious in nail bed changes than those stemming from the matrix. Calcipotriol, both as monotherapy and in combination with corticosteroids, has a long-standing, large body of evidence with reports of around 50% improvement [3–6]. “There is 1 important aspect: you have to treat long term, you have to be patient and the patient has to be patient and consistent; otherwise topical treatments will be a disappointment,” emphasised Prof. van de Kerkhof.
Also, in non-biologic systemic therapy, long-term treatment is necessary. Agents that have shown efficacy in Nail Psoriasis Severity Index (NAPSI) score are acitretin, cyclosporine, and apremilast [7–9]. However, impressive changes in the treatment of nail psoriasis came with the advent of biologics. “Most convincing are the reports of the IL-17 treatment studies: at week 60, improvements of NAPSI of 80% has been reported with ixekizumab, and 63% improvement with secukinumab at week 32, which really is considerable,” Prof. van de Kerkhof said. With biologics, substantial improvement may be already seen after 8 weeks [10]. According to a network meta-analysis of biologics for nail psoriasis, the most effective agent is currently ixekizumab, followed by etanercept [11]. However, when comparison trials are performed for nail psoriasis, one has to bear in mind that there is heterogeneity in the outcome parameters as, for example, even the NAPSI score definition is not overall consistent [1,11,12].
Treatment for nail psoriasis should be individualised, taking into account the impact of the disease on the quality of life of the patient, while also assessing the objective severity [1]. Topicals may be a first step, classical systemics need especially long-term treatment and will not be effective for all patients, and biologics have the greatest efficacy. “My choice is etanercept in case of more moderate nail psoriasis, in more severe nail psoriasis I would opt for ixekizumab,” Prof. van de Kerkhof added.
“Regard nail psoriasis as an important aspect of psoriasis, because serious nail psoriasis makes that the patient requires an effective treatment,” he encouraged dermatologists in his conclusion.
- van de Kerkhof PCM. Nail psoriasis: When and how to treat. D3T11.1C, EADV Congress 2021, 29 Sept–2 Oct.
- Wilson FC, et al. Arthritis Rheum. 2009;61(2):233–9.
- Tosti A, et al. Br J Dermatol. 1998;139(4):655–9.
- Rigopoulos D, et al. Acta Derm Venereol. 2002;82(2):140.
- Tzung TY, et al. Acta Derm Venereol. 2008;88(3):279–80.
- Zakeri M, et al. Dermatol Online J. 2005;11(3):5.
- Tosti A, et al Arch Dermatol. 2009;145(3):269–71.
- Feliciani C, et al. J Cutan Med Surg. 2004;8(2):122–5.
- Reich K, et al. J Eur Acad Dermatol Venereol. 2018;32(3):397–402.
- van de Kerkhof PCM, et al. J Eur Acad Dermatol Venereol. 2017;31(3):477–482.
- Szebenyi J, et al. Acta Derm Venereol. 2020;100(18):adv00318.
- Pasch MC. Drugs. 2016;76(6):675–705.
Copyright ©2021 Medicom Medical Publishers
Posted on
Previous Article
« Grand debate: Is psoriasis a systemic or skin-only disease? Next Article
Ixekizumab superior to secukinumab in real-world psoriasis study »
« Grand debate: Is psoriasis a systemic or skin-only disease? Next Article
Ixekizumab superior to secukinumab in real-world psoriasis study »
Table of Contents: EADV 2021
Featured articles
Letter from the Editor
Long-term disease control in AD could be in reach with anti-OX40 antibody KHK4083
Late-Breaking News
Targeting OX40 in the treatment of atopic dermatitis meets expectations
Superior EASI scores after switch from dupilumab to upadacitinib
CSU: Novel agent targeting Bruton’s tyrosine kinase leads to disease control
Novel JAK3/TEC blocker leads to maintained re-pigmentation in vitiligo
TYK2 inhibitor deucravacitinib shows impressive long-term response in psoriasis
Tapinarof cream for psoriasis leads to high clearance rates and remittive effect
CSU: Ligelizumab likely safe and effective for adolescents
Long-term disease control in AD could be in reach with anti-OX40 antibody KHK4083
Topical JAK1/JAK2 inhibitor effective in vitiligo
Abrocitinib demonstrates fast itch control and skin clearance in atopic dermatitis
AD patients with stable response fare well with a monthly dose of tralokinumab
Opioid receptor agonist difelikefalin disappoints in AD
Atopic Dermatitis: State of the Art
Upadacitinib beats dupilumab in different body regions
Efficacious 2-year AD control with IL-13 inhibitor tralokinumab
Ruxolitinib cream: a safe treatment for elderly AD patients
Novel and upcoming targeted AD treatment
Psoriasis: What's New?
Existing and upcoming small molecules in psoriasis
Treating psoriasis during pregnancies
A patient-related approach to freedom of disease
Ixekizumab superior to secukinumab in real-world psoriasis study
Nail psoriasis: An important target to be treated
Grand debate: Is psoriasis a systemic or skin-only disease?
Spotlight on Alopecia Areata
JAK1/2: A promising novel treatment target in alopecia areata
Alopecia areata: encouraging response rates with JAK3/TEC inhibition
Related Articles
November 18, 2021
Damaged skin as a possible transmission route for SARS-CoV-2
November 18, 2021
Targeting OX40 in the treatment of atopic dermatitis meets expectations
November 18, 2021
Treating psoriasis during pregnancies
© 2024 Medicom Medical Publishers. All rights reserved. Terms and Conditions | Privacy Policy
HEAD OFFICE
Laarderhoogtweg 25
1101 EB Amsterdam
The Netherlands
T: +31 85 4012 560
E: publishers@medicom-publishers.com