The Best Treatment for Nail Psoriasis

 

Psoriasis is a chronic, systemic inflammatory disease with a prevalence as high as 3.1% in the United States. In patients with psoriasis, dysregulation of the immune response is thought to result in a chronic imbalance in the production of proinflammatory and anti-inflammatory cytokines.Available therapies suppress inflammatory responses or target specific mediators implicated in the pathogenesis of psoriasis. However, long-term use of these therapies is often compromised by variable efficacy,safety, and tolerability issues,or need for administration via injection or infusion.

Dermatologic signs and symptoms of psoriasis often occur in difficult-to-treat areas such as the nails and scalp. Nail involvement occurs in approximately 50% of patients with plaque psoriasis, with a lifetime incidence of 80% to 90%; scalp involvement affects up to 80% of patients with psoriasis. Involvement of these difficult-to-treat areas may have particularly detrimental effects on patient quality of life.Treatment of nail and scalp psoriasis with topical therapy is often challenging because of the poor diffusion into the nail tissue and the inaccessibility of scalp lesions. Patient satisfaction and compliance with current treatment modalities for nail and scalp psoriasis are often low because of difficulties in administration to the scalp, poor compliance, and inadequate long-term efficacy.

Although the nails and scalp account for a small percentage of the body surface area, psoriasis in these areas can have a disproportionate effect on a patient’s physical and psychosocial function. Evidence of the efficacy of available therapies in these difficult- to-treat areas is limited, underscoring the need for further clinical evaluation and new treatment options. Nail psoriasis is particularly difficult to treat and may be triggered by an inflammatory response as part of the Koebner phenomenon in patients with moderate to severe chronic plaque psoriasis.Clinical practice recommendations for the treatment of nail psoriasis, published by the Medical Board of the National Psoriasis Foundation, recommend systemic therapies, including apremilast, for patients with significant skin and nail disease or skin, nail, and joint disease. Improvements in nail psoriasis tend to lag behind improvements in skin and joint symptoms, given the time it takes for fingernails to grow out (ie, 3-4 mm/mo, or 5-7 months for growth from the nail matrix to the distal fingertip), such that longer clinical trials are needed to demonstrate effects on nail psoriasis. In ESTEEM, improvements in both nail bed and nail matrix disease were noted with apremilast treatment versus placebo at week 16; improvements continued through week 32 and were maintained through week 52. ( Read more : Natural Way To Get Rid Of Nail Psoriasis at Home )