Nail psoriasis treatment recommendations now available

All patients should be evaluated for onychomycosis
All patients should be evaluated for onychomycosis

HealthDay News -- Treatment recommendations have been developed for patients with nail psoriasis. The recommendations were published in JAMA Dermatology.

“There is an unmet need for treatment recommendations to guide therapeutic decisions,” wrote Jeffrey J. Crowley, MD, of Bakersfield Dermatology in California, and colleagues.

To develop treatment recommendations for nail psoriasis, the investigators reviewed evidence and expert opinion from the Medical Board of the National Psoriasis Foundation. Four clinical nail psoriasis scenarios were developed.

When treating nail psoriasis, providers should consider the extent of the skin disease, psoriatic arthritis, and nail disease severity as well as quality-of-life impairment, noted the authors. Due to its potential for complicating psoriatic nail disease, all patients should be evaluated for onychomycosis.

Initial options for disease limited to the nails include high-potency topical corticosteroids with or without calcipotriol. Treatment with adalimumab, etanercept, intralesional corticosteroids, ustekinumab, methotrexate sodium, and acitretin is recommended for patients with significant nail disease for whom topical therapy has failed.

Adalimumab, etanercept, and ustekinumab are strongly recommended for patients with significant skin and nail disease; methotrexate, acitretin, infliximab, and apremilast are also recommended. Adalimumab, etanercept, ustekinumab, infliximab, methotrexate, apremilast, and golimumab are recommended for patients with significant nail, skin, and joint disease.

"Treatment of nail psoriasis poses a clinical challenge. Clinical trial data are limited, and results are reported inconsistently, making comparisons among treatment options difficult," concluded the researchers.

References

  1. Crowley JJ et al. JAMA Dermatol. 2014; doi: 10.1001/jamadermatol.2014.2983

Disclosures

Several authors disclosed financial ties to the pharmaceutical industry.

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