Treatment of Nail Psoriasis

The Old…According to a Cochrane review, the following shown some evidence in the treatment of Nail Psoriasis (NP):
-infliximab (Remicade)
-golimumab
-superficial radiotherapy
-grenz rays
-electron beam therapy

The New…Randomized Control Sudies are underway (RCT) (at the time of publication)
-With the following anti-TNFs: Certolizumab, Etanercept
-Il-12/23 inhibitors: ustekinumab (Stelara)
-Il17a – inhibitors: secukinumab (Cosentyx)

Unfortuntely studies are difficult to compare with each other as the scoring systems, such as NAPSI are modified; for example in is sometimes measured on 1 digit, sometimes on 8 digits, sometimes on 10 fingers…all in all some consensus is needed.

Topical treatment: what is the evidence ?
Ineffective:
-Clobetasol  0.05%, 1%, 8% nail lacquer
-Pulse-Dye laser
-Nail lacquer-bases chitin extracts from crab nail lacquer-based on chitin extract from crab
-calcitriol ointment combined with bethamethasone dipropionate
Effective:
–tacrolimus ointment
–indigo naturalis in oil (Lindoil) used in TCM (but it has a blue color)

The presenter’s practical way of treating:
-photographic documentation at baseline
-keep nails short
-use of a topical such as a steroid or calcineurin inhibitor for 3 months
-intralesional triamcinolone (Kenocort 10) every 2 months for a duration of 6 months. However it is not effective and very painful
-systemic methotrexate or acitretin

Comment: Apremilast is not mentioned during this presentation although it has shown efficacy in studies.

Nail psoriasis: new scoring systems. Marcel Pasch (Netherlands). SY31 – Clinical Aspects of Psoriasis, Including Co-Morbidities. World Congress of Dermatology 2015 –  Vancouver, Canada