INTRODUCTION
Psoriasis is a chronic inflammatory disease, which can affect the skin, nails and joints. Clinically nails are found to be involved in about 40% of cases at any point in time and the lifetime prevalence is significantly higher.1 Minor changes detected by ultrasonography can be detected in up to 73% of patients.2 The fingernails are more commonly affected than the toes. Characteristic clinical findings are irregular pitting, oil drop sign (salmon patch) and onycholysis. Diagnosis is mainly clinical in cases of associated cutaneous involvement. In isolated cases, there may be a diagnostic dilemma and in those cases, procedures like nail biopsy, dermoscopy or ultrasound may prove to be helpful. Treatment is challenging since the response is slow and is met with poor patient compliance. Different treatment options is demonstrated in Table 1.
Topical Therapy
Topical therapy is considered to be the first line in patients with mild disease or isolated nail involvement. An open label study with 8% clobetaol-17-propionate nail lacquer that was applied once daily for 21 days followed by twice a week for 9 months demonstrated significant improvement for nail bed and matrix psoriasis.3 The topical agent is applied to the nail folds if psoriasis affects the nail matrix, but if it affects the nail bed, then the nail needs to be trimmed before the topical application.4 A study with topical calcipotriol was found to be effective and safe treatment for nail psoriasis without adverse effects.5 In a randomized controlled trial, topical therapy with oral cyclosporine solution was demonstrated cosmetically highly acceptable results in nail psoriasis without adverse effects.6 Calcipotriol-betamethasone valerate ointment applied once daily demonstrated significant improvement in nail psoriasis after 12 weeks.7 A study found treatment with combination of tacalcitol ointment and 8% clobetasol-17-propionate nail lacquer to be effective and safe for nail psoriasis.8
Systemic Therapy
Methotroxate
Methotrexate is an antimetabolite, which inhibits dihyderofolate reductase and is mainly used in dermatology for the treatment of psoriasis. A study with methotrexate (5 mg weekly) demonstrated complete resolution after 9 months for fingers
Topical Therapy
Topical therapy is considered to be the first line in patients with mild disease or isolated nail involvement. An open label study with 8% clobetaol-17-propionate nail lacquer that was applied once daily for 21 days followed by twice a week for 9 months demonstrated significant improvement for nail bed and matrix psoriasis.3 The topical agent is applied to the nail folds if psoriasis affects the nail matrix, but if it affects the nail bed, then the nail needs to be trimmed before the topical application.4 A study with topical calcipotriol was found to be effective and safe treatment for nail psoriasis without adverse effects.5 In a randomized controlled trial, topical therapy with oral cyclosporine solution was demonstrated cosmetically highly acceptable results in nail psoriasis without adverse effects.6 Calcipotriol-betamethasone valerate ointment applied once daily demonstrated significant improvement in nail psoriasis after 12 weeks.7 A study found treatment with combination of tacalcitol ointment and 8% clobetasol-17-propionate nail lacquer to be effective and safe for nail psoriasis.8
Systemic Therapy
Methotroxate
Methotrexate is an antimetabolite, which inhibits dihyderofolate reductase and is mainly used in dermatology for the treatment of psoriasis. A study with methotrexate (5 mg weekly) demonstrated complete resolution after 9 months for fingers
