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

Abstract

Nail involvement in psoriasis is typically overlooked, although it can affect up to 50% of patients with psoriasis and cause functional impact as well as psychological stress that can significantly affect quality of life. In addition, psoriatic patients with nail disease tend to have a more severe skin condition, a higher rate of unremitting and progressive arthritis and more associated anxiety and depression. Historically, the treatment of nail psoriasis has proven difficult, with most patients feeling that the treatment for their nail disease was unsatisfactory. The current management of nail psoriasis includes topical, intralesional and systemic therapies, although little clinical evidence is available on the effectiveness of conventional treatments and, consequently, no specific treatment approach has been fully supported. Biologic agents are beginning to emerge as a viable option to treat patients with both cutaneous and nail clinical manifestations of psoriasis and psoriatic arthritis. The extra disease burden that nail symptoms place on the patient can be considered indicative of a more severe form of the disease and should be taken into consideration when assessing treatment options.

Psoriatic Arthritis and Burden of Disease: Patient Perspectives from the Population-Based Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) Survey

“…Enthesitis and dactylitis, important distinguishing features of PsA in many patients, are associated with more severe disease; both can be difficult to treat and can lead to disability [5,13,31]. Approximately twice as many patients with PsA (21%) had nail involvement compared with patients with psoriasis alone (11%), and 44% of patients with PsA reported scalp involvement; however, overall these rates are lower than those previously reported [8,17,18,21,26]. The presence of skin disease in these areas has been found to have a disproportionate effect on QoL and is often difficult to treat, with limited effective treatment options [7,9,19,21].…”

Detailed Analysis of Specific Nail Psoriasis Features and Their Correlations with Clinical Parameters: A Cross-Sectional Study

“…The majority of the researchers have reported that the frequency of nail involvement in psoriatic patients is about 75–83% [2,6,7,8,16], although there are reports asserting that it is between 10 and 55% [1,3,4,5,9,11]. Moreover, there are reports mentioning that 80–90% of the psoriatic patients will develop nail psoriasis at some point of their lives [1,9,11,12]. Isolated nail psoriasis, without any skin or joint manifestation, is observed in only 1–10% of the patients [3,8,9,11].…”

“…Nail psoriasis occurrence considerably varies and ranges between 10 and 90% [1,2,3,4,5,6,7,8,9,10,11]. Additionally, it is reported that 80–90% of patients with psoriasis will develop nail psoriasis at some point of their lives [1,2,11,12]. Rarely, isolated nail psoriasis can be observed, but only in 1–10% of patients with psoriasis [3,8,9,11].…”

“…Additionally, it is reported that 80–90% of patients with psoriasis will develop nail psoriasis at some point of their lives [1,2,11,12]. Rarely, isolated nail psoriasis can be observed, but only in 1–10% of patients with psoriasis [3,8,9,11]. It is mentioned that psoriatic arthritis is associated with higher rates of nail disease than psoriasis alone [8,9,13], whereas in patients with psoriatic arthritis, the severity of nail disease correlates with indicators of severity of both skin and joint disease [9,13].…”

A Study on Psoriasis of Nails- Severity Scoring System

“…[2] [3] There is no sex predilection. Patients above 40 years of age are affected twice as often as those under 20 years.…”