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.
Objective To evaluate re-treatment with weekly adalimumab in patients with moderate to severe psoriasis who had been successfully treated with weekly adalimumab but relapsed following randomization to either dosage reduction or discontinuation. Methods Patients who had achieved a Psoriasis Area and Severity Index (PASI) response of 50 or greater after 12 weeks on adalimumab 40 mg weekly in a previous study (M02-538), but then fell below a PASI 50 response within 12 weeks following reduction of dosage frequency to adalimumab 40 mg every other week or treatment discontinuation, could enter study M03-596 and receive open-label re-treatment with 12 weeks of weekly adalimumab. Results Thirty-two patients relapsed on or before week 24 of M02-538 and entered study M03-596. Overall, 81.3% (26 of 32) again achieved a PASI 50 response after 12 weeks of re-treatment. Of the 19 M03-596 patients who had a PASI 75 response at week 12 of M02-538, 12 (63.1%) again achieved a PASI 75 response at week 12 of M03-596. Conclusion Most patients who had initially responded to weekly adalimumab and who relapsed after randomization to a lower dosage or discontinuation regained response upon re-treatment with weekly adalimumab.
Psoriasis is an immune-mediated disease of complex etiology. This article discusses four medications that “failed” for treatment of psoriasis, each for a different reason. Efalizumab “failed” because patients developed progressive multifocal leukoencephalopathy and the drug was taken off the market. Benoxaprofen was shown to be effective for psoriasis in several small trials. However, the medication was withdrawn from the market due to numerous side effects, including hepatic failure. CTLA4-Ig (abatacept) is currently approved for the treatment of adult rheumatoid arthritis and idiopathic juvenile arthritis and is effective for the treatment of psoriasis. However, a high dose is necessary and cost of the medication becomes prohibitive. In several studies, mycophenolic acid was shown to be effective for treating psoriasis. However, its use is limited because of a wide range of side effects. More specific treatments with fewer side effects should become available as our understanding of psoriasis continues to increase.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.