Effectiveness of systemic treatment agents on psoriatic nails: a comparative study

Area of Science:

• Dermatology
• Rheumatology
• Pharmacology

Background:

• Nail psoriasis is common, visible, and challenging to treat topically due to nail anatomy.
• Systemic therapy often improves nail psoriasis but may be necessary even with low skin psoriasis scores.
• Identifying potent systemic agents for nail psoriasis is crucial.

Purpose of the Study:

• To evaluate the efficacy of various systemic antipsoriatic agents on nail psoriasis.
• To compare the impact of different treatments on both nail and skin psoriasis severity.

Main Methods:

• Eighty-seven patients with fingernail psoriasis requiring systemic treatment were studied.
• Patients received methotrexate, narrow-band UVB, biological agents, or acitretin; a control group received no systemic treatment.
• Nail Psoriasis Severity Index (NAPSI) and Psoriasis Area and Severity Index (PASI) were assessed at baseline and week 16.

Main Results:

• Conventional agents (methotrexate, phototherapy, acitretin) significantly reduced PASI but not NAPSI compared to controls.
• Biological agents demonstrated a statistically significant improvement in NAPSI compared to the control group.
• PASI scores decreased significantly across all treatment groups, indicating efficacy for skin psoriasis.

Conclusions:

• Biological agents are more effective than conventional systemic treatments for nail psoriasis.
• Conventional systemic therapies may not significantly improve nail psoriasis despite improving skin psoriasis.
• Further research into targeted therapies for nail psoriasis is warranted.