Treatment recommendations developed for nail psoriasis

(HealthDay)—Treatment recommendations have been developed for patients with nail psoriasis. The recommendations were published online Dec. 3 in JAMA Dermatology.

Jeffrey J. Crowley, M.D., from Bakersfield Dermatology in California, and colleagues developed treatment guidelines for nail psoriasis. Based on evidence reviewed and the expert opinion of the Medical Board of the National Psoriasis Foundation, recommendations for four clinical nail psoriasis scenarios were developed.

The authors note that when treating nail psoriasis physicians should consider the extent of skin disease, psoriatic arthritis, and nail disease severity as well as quality-of-life impairment. 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," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.