Nail Psoriasis: A Review of Effective Therapies and Recommendations for Management

Hadeler, Edward; Mosca, Megan; Hong, Julie; Brownstone, Nicholas; Bhutani, Tina; Liao, Wilson

doi:10.1007/s13555-021-00523-x

Cited by 17 publications

(14 citation statements)

References 66 publications

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“…Nail psoriasis mostly demonstrates as nail pitting. Other presentations range from oil drop discoloration, splinter hemorrhaging of the nail bed to crumbling or loosening of the nail plate ( 17 ). Of note, it is an important predictor for psoriatic arthritis (PsA) ( 18 ).…”

Section: Classifications Of Psoriasismentioning

confidence: 99%

Cutaneous and Systemic Psoriasis: Classifications and Classification for the Distinction

Yan

Chen

et al. 2021

Front. Med.

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Psoriasis is a chronic multisystem inflammatory disease that affects ~0.1–1.5% of the world population. The classic cutaneous manifestation of psoriasis is scaly erythematous plaques, limited or widely distributed. Moreover, psoriasis could be associated with comorbidities like psoriatic arthritis, metabolic syndrome, diabetes, cardiovascular disease, nephropathy, bowel disease, and brain diseases. In this review, we suggest that psoriasis should be classified as cutaneous psoriasis or systemic psoriasis and propose the classification for distinction. This would help to better understand and manage psoriasis.

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Section: Classifications Of Psoriasismentioning

confidence: 99%

Cutaneous and Systemic Psoriasis: Classifications and Classification for the Distinction

Yan

Chen

et al. 2021

Front. Med.

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“…Similar results have been observed in the efficacy of IL-17 and IL-23 antibodies in the treatment of nail psoriasis. Particularly in the long term, the efficacy of all these three classes of biologics, anti-TNFα, anti-IL-17 and anti-IL-23, on nail psoriasis does not seem to differ significantly [34]. A personalized approach should be considered in Pso patients with PsA and nail involvement.…”

Section: Discussionmentioning

confidence: 99%

The Effect of TNF-α Inhibitors on Nail Psoriasis and Psoriatic Arthritis—Real-World Data from Dermatology Practice

Kokolakis

Sabat

Fischer

et al. 2021

JPM

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Patients with psoriatic arthritis (PsA) often develop joint symptoms years after their initial diagnosis of psoriasis disease; therefore, dermatologists should test for and detect PsA early. In this study, we focused on patients with psoriasis with both nail and joint disease being treated with tumor necrosis factor-α inhibitors by dermatologists. We performed a noninterventional, prospective, multicenter, and open-label study to evaluate the effectiveness of adalimumab, etanercept, or infliximab over 24 months of continuous therapy in patients with moderate to severe plaque-type psoriasis (Pso) and PsA. Disease assessments with the Psoriasis Area and Severity Index, Nail Psoriasis Severity Index (NAPSI), joint assessment, Dermatology Life Quality Index (DLQI), and Health Assessment Questionnaire (HAQ) instruments were performed every 3 months for the first year and twice annually thereafter. The cohort included 100 patients with Pso, nail psoriasis, and PsA. A significant reduction of NAPSI was observed 3 months after therapy initiation compared with the baseline (mean ± SD, 22.9 ± 17.8 vs. 33.8 ± 21.4; p < 0.001). Similarly, the mean ± SD number of both tender and swollen joints decreased significantly within the first 3 months of treatment, from 10.8 ± 11.5 to 6.4 ± 10.3 (p < 0.001) and from 6.4 ± 9.5 to 3.1 ± 7.2 (p < 0.001), respectively. Additionally, the distal interphalangeal joint involvement improved throughout the observation time, and DLQI and HAQ scores decreased. Improvements in control of skin, nail, and joint symptoms were seen, as well as in patients’ quality of life and functionality. Dermatologists have an important role not only in PsA diagnosis but also in PsA long-term care.

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“…Recent reviews and guidelines have highlighted the efficacy of biologics in nail psoriasis treatment [ 32 , 33 ]. Biologics such as TNFα inhibitors have been recommended for severe or worsening nail lesions that are uncontrolled with topical or conventional systemic therapies, with or without concomitant psoriatic joint disease [ 3 , 28 ].…”

Section: Nail Psoriasismentioning

confidence: 99%

“…Biologics targeting the IL-17 pathway have demonstrated higher rates of efficacy versus IL-12/IL-23 or IL-23 inhibitors (brodalumab versus ustekinumab; ixekizumab versus guselkumab) and TNFα inhibitors (ixekizumab versus etanercept) in treating nail psoriasis. Certain TNFα inhibitors were shown to have similar efficacy to IL-23 inhibitors (adalimumab versus guselkumab) [ 32 ]. According to a recent network metaanalysis evaluating psoriasis with nail involvement in 17 RCTs, all active biologics were generally better than placebo in clearance of nail psoriasis.…”

Section: Nail Psoriasismentioning

confidence: 99%

Narrative Review of the Emerging Therapeutic Role of Brodalumab in Difficult-to-Treat Psoriasis

Menter

Bhutani

Ehst

et al. 2022

Dermatol Ther (Heidelb)

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Psoriatic involvement in areas of the body such as nails, palms and soles (palmoplantar), and scalp is associated with dramatically negative effects on quality of life relative to involvement elsewhere in the body. Although numerous evidence-based studies demonstrate the efficacy of biologics for overall skin clearance in moderate-to-severe plaque psoriasis (including tumor necrosis factor α [TNFα] inhibitors and interleukin [IL]-17A, IL-12/IL-23, IL-23, IL-17F, and IL-17A/F inhibitors), large, randomized, placebo-controlled clinical studies of psoriasis with nail, palmoplantar, and scalp involvement are needed to better inform decision-making in clinical practice. Moreover, biologic failure caused by drug ineffectiveness is a common occurrence in patients who do not respond, lose response, or are intolerant to treatment. Brodalumab is a fully human IL-17 receptor A antagonist that demonstrates high rates of skin clearance among the latest generation of biologic therapies for treatment of moderate-to-severe psoriasis. This review summarizes current literature on the efficacy of brodalumab and other therapies in difficult-to-treat psoriasis including psoriasis in difficult-to-treat locations (such as psoriasis with nail, palmoplantar, or scalp involvement) and psoriasis in patients whose disease did not respond to other biologics.

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Nail Psoriasis: A Review of Effective Therapies and Recommendations for Management

Cited by 17 publications

References 66 publications

Cutaneous and Systemic Psoriasis: Classifications and Classification for the Distinction

Cutaneous and Systemic Psoriasis: Classifications and Classification for the Distinction

The Effect of TNF-α Inhibitors on Nail Psoriasis and Psoriatic Arthritis—Real-World Data from Dermatology Practice

Narrative Review of the Emerging Therapeutic Role of Brodalumab in Difficult-to-Treat Psoriasis

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