Mild-severity patients received calcipotriol, topical steroids or oral nimesulide with only calcipotriol presenting efficacy comparable to retinoids. There are presently few available studies on biological therapy for nail psoriasis, but there are many in progress. The recent design of the Nail Psoriasis Severity Index allows a more standarized approach regarding outcome assessment. Topical treatments, including corticosteroids, calcipotriol, tacrolimus, and tazarotene, have also been shown to have a position in the treatment of nail psoriasis, particularly in mild cases. Nail psoriasis can be treated effectively using topical treatments, intralesional treatments, and systemic treatments, but an optimal effect may take up to 1 year. The titles and abstracts of each of these publications were evaluated and a total of 72 studies or case reports on the treatment of nail psoriasis were selected for complete reviewing. In spite of the long history of corticosteroids in the treatment of nail psoriasis, only a few formal trials of their efficacy have been conducted.
For disease limited to the nails, high-potency topical corticosteroids with or without calcipotriol are initial options. The articles were evaluated with levels of evidence as reported by Shekelle et al. These patients have psoriasis on 8 of their body surface area, 5 of 10 nails with severe nail dystrophy, and moderate to severe nail-associated pain. Patches appear as red scaly areas on the scalp, behind the ears, above the shoulder blades, in the armpits or groin, or in the center of the face. Over half of patients with psoriasis have abnormal changes in their nails, which may appear before other skin symptoms. There have been a few reports of serious infections and cancer. Symptoms that responded best to treatment were pitting and onycholysis, and no side-effects were reported 24. Psoriasis of the nail: anatomy, pathology, clinical presentation, and a review of the literature on therapy. Nail psoriasis: combined therapy with systemic cyclosporin and topical calcipotriol.
Psoriasis localized to certain areas of the body like scalp, nails, palms and soles remains difficult to treat. However, in case of severe involvement of these sites or in patients who are refractory to topical therapy, systemic therapy is warranted. There are not many controlled clinical trials on the treatment of palmoplantar psoriasis in literature. There are also reports in literature on the improvement in palmoplantar pustulosis (PPP) with cessation of smoking and surgical interventions like tonsillectomy and shunt surgeries. Psoriatic lesions in a few nails. There is an association between the duration of psoriasis and the severity of nail involvement 2, 3, 5. In a double-blind study involving 58 patients with nail bed psoriasis, topical application of calcipotriol ointment twice daily was found to be as effective as twice daily application of betamethasone dipropionate in reducing subungual hyperkeratosis after 3 9 months 30. Although the efficacy of methotrexate and cyclosporine on plaque type psoriasis has been reported previously, the literature consists of few publications regarding the efficacy of the two treatment agents in the nail involvement. Treatment of nail psoriasis includes different types of medications, from topical therapy to systemic therapy, according to the severity and extension of the disease. It is possible to observe an isolated involvement of a few fingers or lesions of all nails on both hands and feet. There are many different scores specifically developed to assess the severity and to evaluate the courses of both disease and therapy in nail psoriasis. In an open study, 62 patients were treated with topical calcipotriol once daily 5 days a week, as well as with clobetasol propionate (0.
Worse yet, a few of the common prescription medications used to treat nail disorders have potentially significant side effects, especially liver damage. Nail psoriasis. This nail abnormality occurs primarily in people with psoriasis of the skin; it is seen in about 80 percent of people with inflammatory arthritis associated with psoriasis, especially when the arthritis affects the toes and fingers. One multicenter study reported that diabetics are nearly three times more likely to develop onychomycosis than non-diabetics; also, up to one-third of diabetics may develop nail fungus (Gupta 1998). Although both topical and oral medications are available, topical agents typically are not very effective because infections are usually under the nail, and topical medications cannot penetrate the nail plate (Kyle 2004). Treatment options for individuals with psoriasis on their hands, feet and/or nails. There are several treatments that can help psoriasis in these areas. A few lifestyle changes also can ease the discomfort of hand, feet and nail psoriasis. A regimen alternating calcipotriene and potent topical corticosteroids may be helpful. About Us Annual Report Employment Event Calendar Press Room. Nail psoriasis characterized by pitting, onycholysis and hyperkeratosis under the nail is frequently confused with nail fungus (14). Calcipotriol is a safe and effective treatment in children with mild to moderate plaque-like psoriasis associated with 30 of skin involvement. There are several studies regarding the successful treatment by topical Calcineurin inhibitors for psoriasis in adults (23-25). Although retinoids have been used widely in inherited disorders of keratinization, there are a few case reports and case series regarding the administration of Acitretin in the treatment of childhood psoriasis. Plaque psoriasis can appear on any skin surface, although the knees, elbows, scalp, trunk and nails are the most common locations. In addition, there is no adequate evidence of the effectiveness of laser therapy in combination with topical therapy. Lesions remained in remission with as few as a single high fluence (up to 16 times the minimal erythemogenic dose (MED)) treatment, whereas recurrences occurred in lesions treated with multiple doses of lower fluences shortly after cessation of treatment. Feldman et al (2002) reported on a multi-center study of the excimer laser involving 124 patients with stable mild-to-moderate plaque-type psoriasis; 32 of whom dropped out of the study before completing the course of treatment. Patient have information on symptoms, treatments and potential causes of psoriasis online. Many people have just a few small plaques of a centimetre or so when their psoriasis flares up. Nail psoriasis may also occur alone without the skin rash. Unless psoriasis is very severe, treatment tends to start with topical treatments. Note: if you are using calcipotriol as a cream or ointment for your body and you are using a scalp lotion that contains calcipotriol, you need to consider both of these. This study aimed to assess the therapeutic effects of oral prednisolone along with the common adjuvant therapy in pemphigus vulgaris. There are few reports regarding the treatment of nail psoriasis with topical calcipotriol. We undertook a case series study to evaluate the efficacy and safety of calcipotriol ointment (50 microg/g) in the treatment of nail psoriasis in 24 patients.