Nail Psoriasis: A Review

Nail psoriasis is common, occurring in up to half of patients with psoriasis and in 90% of patients with psoriatic arthritis. Left untreated, it may progress to debilitating nail disease, which leads to significant functional impairment. The most common clinical signs of nail psoriasis are nail plat...

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Bibliographic Details
Published in:American journal of clinical dermatology 2012-12, Vol.13 (6), p.375-388
Main Authors: Tan, Eugene S. T., Chong, Wei-Sheng, Tey, Hong Liang
Format: Article
Language:English
Subjects:
Arthritis, Psoriatic - complications
Arthritis, Psoriatic - pathology
Arthritis, Psoriatic - therapy
Biological and medical sciences
Dermatologic Agents - administration & dosage
Dermatologic Agents - therapeutic use
Dermatology
Disease Progression
Humans
Immunologic Factors - administration & dosage
Immunologic Factors - therapeutic use
Laser Therapy - methods
Medical sciences
Medicine
Medicine & Public Health
Nail Diseases - etiology
Nail Diseases - pathology
Nail Diseases - therapy
Pharmacology/Toxicology
Pharmacotherapy
Photochemotherapy - methods
Psoriasis - complications
Psoriasis - pathology
Psoriasis - therapy
Psoriasis. Parapsoriasis. Lichen
Quality of Life
Review Article
Severity of Illness Index
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Summary:Nail psoriasis is common, occurring in up to half of patients with psoriasis and in 90% of patients with psoriatic arthritis. Left untreated, it may progress to debilitating nail disease, which leads to significant functional impairment. The most common clinical signs of nail psoriasis are nail plate pitting and onycholysis. Other classical signs include oil drop discoloration, subungual hyperkeratosis, and splinter hemorrhages. The modified Nail Psoriasis Severity Index (mNAPSI) can be used to grade the severity of nail psoriasis, while the Nail Psoriasis Quality of Life Scale (NPQ10) is a questionnaire that evaluates the impact of nail psoriasis on the patient’s functional status and quality of life. Treatment of nail psoriasis should be individualized according to the patient’s preferences, severity of nail changes, and presence of skin and/or joint involvement. Both topical and intralesional therapies are safe and effective treatment modalities for nail disease, but are limited by poor adherence and pain, respectively. Systemic therapy such as oral retinoids may be considered for widespread nail disease causing significant morbidity. Among biologic agents, tumor necrosis factor-a inhibitors and T-cell-targeted therapies such as ustekinumab may be useful for refractory severe nail psoriasis.
ISSN:1175-0561
1179-1888
DOI:10.2165/11597000-000000000-00000