Nail psoriasis: clinical features, pathogenesis, differential diagnoses, and management

Area of Science:

• Dermatology
• Rheumatology
• Immunology

Background:

• Psoriasis frequently affects the nails, leading to diverse clinical presentations.
• Nail involvement varies based on the specific nail structure affected, ranging from pitting to dystrophy.
• Nail psoriasis significantly diminishes patients' quality of life and functional capacity.

Purpose of the Study:

• To detail the clinical manifestations of nail psoriasis based on anatomical location.
• To review current and emerging treatment modalities for nail psoriasis.
• To highlight the impact of nail psoriasis on patient well-being.

Main Methods:

• Clinical observation and classification of nail alterations.
• Review of therapeutic interventions for nail psoriasis.
• Assessment of treatment efficacy and limitations.

Main Results:

• Specific nail changes correlate with the site of matrix or nail bed involvement (e.g., pits, leukonychia, onycholysis).
• Topical treatments are often insufficient; systemic therapies and injections offer some benefit but have drawbacks.
• Biological agents represent a highly effective, albeit costly, option for severe nail psoriasis.

Conclusions:

• Understanding the specific nail structures involved aids in diagnosing and managing nail psoriasis.
• A multimodal approach to treatment is often necessary, tailored to disease severity.
• Emerging biological therapies offer new hope for patients with severe and refractory nail psoriasis.