Main Article Content
nail psoriasis, psoriatic arthritis, psoriasis,
Psoriasis is a chronic, inflammatory disease with a diverse array of clinical manifestations involving the skin, joints, and nails. Of these, nail psoriasis is a frequently overlooked, yet important complication of psoriasis which can cause significant physical and psychological distress to a patient. Psoriasis affecting the nail unit can pose both diagnostic and therapeutic challenges to physicians due to its clinical heterogeneity, the multitude of available treatment options, and the general lack of high-quality research on the subject. In order to aid the practicing clinician in appropriate diagnosis and treatment of nail psoriasis, this review provides an overview of the epidemiological, clinical, and pathophysiologic features of the disease, while also attempting to develop a rationale for effective medical management of the condition.
Bhutani T, Koo J, Hong J. (2011). Contemporary Diagnosis and Management of Psoriasis. Newtown, Penn: Associates in Medical Marketing Co., Inc.
Pariser DM, Bagel J, Gelfand JM, Korman NJ, Ritchlin CT, Strober BE,et al. National Psoriasis Foundation Clinical Consensus on Disease Severity. Arch Dermatol 2007;143:239‑24
Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70(3):512-6.
Baliwag J, Barnes DH, Johnston A. (2015). Cytokines in psoriasis. Cytokine, 73(2), 342–350.
Klaassen KM, van de Kerkhof PC, Pasch MC. Nail psoriasis: a questionnaire-based survey. Br J Dermatol. 2013;169(2):314-9.
Van Der Velden HMJ, Klaassen KM, Peter CM,Van De Kerkhof PC, Pasch MC. Fingernail psoriasis reconsidered: a case-control study J. Am. Acad. Dermatol., 69 (2) (2013), pp. 245–252
Tan ES, Chong WS, Tey HL. Nail Psoriasis: A Review. Am J Clin Dermatol. 2012;13:375–388.
Salomon J, Szepietowski JC, Proniewicz A. Psoriatic nails: a prospective clinical study. J Cutan Med Surg. 2003;7(4):317–21.
Haneke, E. (2015). Anatomy of the nail unit and the nail biopsy. Seminars In Cutaneous Medicine And Surgery, 34(2), 95-100.
Koo, J. (1996). Population-based epidemiologic study of psoriasis with emphasis on quality of life assessment. Dermatologic Clinics, 14(3), 485-496.
Jiaravuthisan, MM, Sasseville D, Vender RB, Murphy F, Muhn CY. (2007). Psoriasis of the nail: anatomy, pathology, clinical presentation, and a review of the literature on therapy. Journal Of The American Academy Of Dermatology, 57(1), 1-27.
Dogra A, Arora AK. (2014). Nail Psoriasis: The Journey So Far. Indian Journal Of Dermatology, nt dmlkk59(4), 319-333.
Zisova L, Valtchev V, Sotiriou E, Gospodinov D, Mateev G. (2012). Onychomycosis in patients with psoriasis - a multicentre study. Mycoses, 55(2), 143-147.
Gupta AK, Lynde CW, Jain HC, Sibbald RG, Elewski BE, Daniel C, Summerbell RC. (1997). A higher prevalence of onychomycosis in psoriatics compared with non-psoriatics: a multicentre study. The British Journal Of Dermatology, 136(5), 786-789.
Grover C, Reddy B, Uma Chaturvedi K. (n.d). Diagnosis of nail psoriasis: importance of biopsy and histopathology. British Journal Of Dermatology, 153(6), 1153-1158.
Batkaeva NV, Korotaeva TV, Batkaev EA. Prevalence of psoriatic arthritis and comorbidities in patients with severe psoriasis: Data of a retrospective analysis of a hospital cohort. Sovremennaâ Revmatologiâ, Vol 11, Iss 1, Pp 19-22 (2017). 2017;(1) 19.
Gladman D, Chandran V. Psoriatic Arthritis. Oxford: OUP Oxford; 2009.
Williamson L, Dalbeth N, Dockerty JL, Gee BC, Weatherall R, Wordsworth BP. Extended report: nail disease in psoriatic arthritis-clinically important, potentially treatable and often overlooked. Rheumatology 2004: 43: 790–794.
Reich K, Kruger K, Mossner R, Augustin M. Epidemiology and clinical pattern of psoriatic arthritis in Germany: a prospective interdisciplinary epidemiological study of 1511 patients with plaque-type psoriasis. Br J Dermatol. 2009;160(5):1040–7.
Gudjonsson J, Karason A, Antonsdottir A, Runarsdottir E, Gulcher J, Stefansson K, Valdimarsson H. (n.d). HLA-Cw6-positive and HLA-Cw6-negative patients with psoriasis vulgaris have distinct clinical features. Journal Of Investigative Dermatology, 118(2), 362-365.
Merola JF, Lockshin B, Mody EA. (2017). Switching biologics in the treatment of psoriatic arthritis. Seminars In Arthritis And Rheumatism.
Pasch M. Nail Psoriasis: A Review of Treatment Options. Drugs. April 15, 2016;76(6):675-705.
de Vries A. Interventions for nail psoriasis. Cochrane Database Of Systematic
Reviews. December 11, 2012;(1).
Gregoriou S, Kalogeromitros D, Kosionis N, Gkouvi A, Rigopoulos D. Treatment
options for nail psoriasis. Expert Rev Dermatol 2008;3:339-44.
Baran R, Tosti A. Topical treatment of nail psoriasis with a new corticoid-containing nail lacquer formulation. Journal Of Dermatological Treatment. September 1999;10(3):201.
Nakamura RC, Abreu Ld, Duque-estrada B, Tamler C, Leverone AP. 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):203-11.
Tosti A, Piraccini B, Benelli C, et al. Calcipotriol ointment in nail psoriasis: a controlled double-blind comparison with betamethasone dipropionate and salicylic acid. The British Journal Of Dermatology. October 1998;139(4):655-659.
Tzung T, Chen C, Yang C, Lo P, Chen Y. Calcipotriol used as monotherapy or combination therapy with betamethasone dipropionate in the treatment of nail psoriasis. Acta Dermato-Venereologica. 2008;88(3):279-280.
Rigopoulos D, Gregoriou S, Daniel I,C.R., et al. Treatment of nail psoriasis with a two-compound formulation of calcipotriol plus betamethasone dipropionate ointment. Dermatology. 2009;218(4):338-41.
Scher RK, Stiller M, Zhu YI. Tazarotene 0.1% gel in the treatment of fingernail psoriasis: A double-blind, randomized, vehicle-controlled study. Cutis. 2001;68(5):355-8.
Yamamoto T, Katayama I, Nishioka K. Topical anthralin therapy for refractory nail psoriasis. J Dermatol. 1998;25(4):231-3.
Lin Y, See L, Lin N, et al. Efficacy and safety of Indigo naturalis extract in oil (Lindioil) in treating nail psoriasis: A randomized, observer-blind, vehicle-controlled trial. Phytomedicine. June 15, 2014;21:1015-1020.
Cannavò S, Guarneri F, Vaccaro M, Borgia F, Guarneri B. Treatment of psoriatic nails with topical cyclosporine: a prospective, randomized placebo-controlled study. Dermatology (Basel, Switzerland). 2003;206(2):153-156.
de Jong E, Menke H, van Praag M, van De Kerkhof P. Dystrophic psoriatic fingernails treated with 1% 5-fluorouracil in a nail penetration-enhancing vehicle: a double-blind study. Dermatology (Basel, Switzerland). 1999;199(4):313-318.
de Berker D. Management of psoriatic nail disease. Semin Cutan Med Surg. 2009;28(1):39–43.
Edwards F, de Berker D. Nail psoriasis: clinical presentation and best practice recommendations. Drugs [serial online]. December 3, 2009;69(17):2351-2361.
Gümüşel M, Özdemir M, Mevlitoğlu I, Bodur S. Evaluation of the efficacy of methotrexate and cyclosporine therapies on psoriatic nails: a one-blind, randomized study. Journal Of The European Academy Of Dermatology And Venereology: JEADV . September 2011;25(9):1080-1084.
Reich K, Langley R, Valdes J, et al. A 52-Week Trial Comparing Briakinumab with Methotrexate in Patients with Psoriasis. New England Journal Of Medicine. October 27, 2011;365(17):1586-1596.
Mahrle G, Schulze H, Färber L, Weidinger G, Steigleder G, other multicenter c. Low-dose short-term cyclosporine versus etretinate in psoriasis: Improvement of skin, nail, and joint involvement. Journal Of The American Academy Of Dermatology. January 1, 1995;32:78-88.
Tosti A, Ricotti C, Romanelli P, Cameli N, Piraccini B. Evaluation of the Efficacy of Acitretin Therapy for Nail Psoriasis. Archives Of Dermatology. March 2009;145(3):269-271.
Rich P, Gooderham M, Crowley J, et al. Original article: 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). Journal Of The American Academy Of Dermatology. September 1, 2015.
Crowley J, Weinberg J, Wu J, Robertson A, Van Voorhees A. Treatment of Nail Psoriasis Best Practice Recommendations From the Medical Board of the National Psoriasis Foundation. Jama Dermatology. n.d.;151(1):87-94.
Rich P, Griffiths C, Guzzo C, et al. Report: Baseline nail disease in patients with moderate to severe psoriasis and response to treatment with infliximab during 1 year. Journal Of The American Academy Of Dermatology. January 1, 2008;58:224-231.
Reich K, Ortonne J, Griffiths C, et al. Skin and Nail Responses after 1 Year of Infliximab Therapy in Patients with Moderate-to-Severe Psoriasis: A Retrospective Analysis of the EXPRESS Trial. Dermatology. 2010;221(2):172-178.
Luger T, Barker J, Boggs R, et al. Sustained improvement in joint pain and nail symptoms with etanercept therapy in patients with moderate-to-severe psoriasis. Journal Of The European Academy Of Dermatology And Venereology. August 2009;23(8):896-904.
Van den Bosch F, Manger B, Kupper H, et al. Effectiveness of adalimumab in treating patients with active psoriatic arthritis and predictors of good clinical responses for arthritis, skin and nail lesions. Annals Of The Rheumatic Diseases. February 2010.;69(2):394-399.
Saraceno R, Pietroleonardo L, Mazzotta A, Zangrilli A, Bianchi L, Chimenti S. TNF-α antagonists and nail psoriasis: an open, 24-week, prospective cohort study in adult patients with psoriasis. Expert Opinion On Biological Therapy. April 2013;13(4):469-473.
Kavanaugh A, van der Heijde D, Beutler A, et al. Golimumab in psoriatic arthritis: one-year clinical efficacy, radiographic, and safety results from a phase III, randomized, placebo-controlled trial. Arthritis And Rheumatism. August 2012;64(8):2504-2517.
Reich K, Sullivan J, Arenberger P, et al. Secukinumab is effective in subjects with moderate to severe plaque psoriasis with significant nail involvement: 16 week results from the TRANSFIGURE study. Presented at: 23rd World Congress of Dermatology; Vancouver, Canada; June 8–15, 2015.
Paul C, Reich K, Papavassilis C, et al. 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. Journal Of The European Academy Of Dermatology And Venereology: JEADV. December 2014;28(12):1670-1675.
Leonardi C, Matheson R, Banerjee S, et al. Anti-interleukin-17 monoclonal antibody ixekizumab in chronic plaque psoriasis. New England Journal Of Medicine. March 29, 2012;366(13):1190-1199.
Rich P, Bourcier M, Poulin Y, et al. Ustekinumab improves nail disease in patients with moderate-to-severe psoriasis: results from PHOENIX 1. British Journal Of Dermatology. February 2014;170(2):398-407.
Igarashi A, Kato T, Kato M, Song M, Nakagawa H. Efficacy and safety of ustekinumab in Japanese patients with moderate-to-severe plaque-type psoriasis: Long-term results from a phase 2/3 clinical trial. Journal Of Dermatology. March 2012;39(3):242-252.
Merola J, Elewski B, Tatulych S, Lan S, Tallman A, Kaur M. Efficacy of tofacitinib for the treatment of nail psoriasis: Two 52-week, randomized, controlled phase 3 studies in patients with moderate-to-severe plaque psoriasis. Journal Of The American Academy Of Dermatology. April 7, 2017.
de Berker D. Biologics in nail psoriasis. The British Journal Of Dermatology. February 2014;170(2):236-237.
Manhart R, Rich P. Nail psoriasis. Clinical And Experimental Rheumatology. n.d.;33(5):S7-S13.