Response of psoriatic nails to oral photochemotherapy

Abstract

Ten patients with generalized psoriasis, which included nail involvement, were treated with total-body oral photochemotherapy. A combination of methoxsalen and high-intensity ultraviolet A radiation was employed and its therapeutic efficacy in nail psoriasis ascertained. Among the ten patients, there were 26 instances of the following nail signs: pitting, onycholysis, "oil drop" change, subungual hyperkeratosis, nail-plate crumbling, proximal nail-fold psoriasis, and onychorrhexis. Of the 26, eighteen improved by 50% or more. Only pitting failed to respond to therapy in all of the eight patients who had this change.

Psoriasis of the nail: Anatomy, pathology, clinical presentation, and a review of the literature on therapy

“…Oral PUVA appeared to be quite beneficial in patients who had PNF involvement and nail plate crumbling, 109 while topical PUVA demonstrated its efficacy on isolated cases of pitting and onycholysis. 110 Superficial radiotherapy showed mixed results, as one study documented complete clearance of subungual hyperkeratosis, discoloration, and cracking in 3 patients, with 1 subject in remission for 20 years, 111 while another study showed no improvement for patients suffering from pitting, onycholysis, subungual hyperkeratosis, and destruction of nail plate.…”

“…108 Although the efficacy of phototherapy and photochemotherapy has been widely validated for treating psoriasis of the skin, there has been a clear absence of evidence pertaining to its value in nail psoriasis therapy. Marx and Scher 109 published J AM ACAD DERMATOL VOLUME 57, NUMBER 1 a prospective study in 1980 in which 10 patients (a total of 26 separate dystrophies), who had generalized psoriasis with nail involvement, were treated with oral photochemotherapy (Table V). The regimen consisted of methoxsalen, at a dose of 0.6 mg/kg, and high intensity UVA radiation, which was administered 2 to 3 times a week.…”

Nail psoriasis: The journey so far

“…Marx and Scher[79] published a prospective study in 1980 in which 10 patients (a total of 26 separate dystrophies), who had generalized psoriasis with nail involvement were treated with oral photochemotherapy. The regimen consisted of methoxsalen, at a dose of 0.6 mg/kg and high-intensity UVA radiation, which was administered 2-3 times a week.…”

Treatment and Management of Psoriasis with Nail Involvement: A Focus on Biologic Therapy

“…Psoralen plus ultraviolet A (PUVA) is one of the most common photochemotherapeutic regimens. The psoralen can be administered orally or topically, and at times, the nails can be soaked in the solution before exposure to ultraviolet A. PUVA appears to be successful in treating psoriasis arising from the nail bed (e.g., onycholysis, subungual hyperkeratosis) but does little to improve some nail matrix disease symptoms (e.g., pitting) [30,31]. …”