Management of nail psoriasis.

Area of Science:

• Dermatology
• Rheumatology
• Immunology

Background:

• Nail psoriasis affects 80-90% of psoriasis patients, often indicating severe disease.
• Nail involvement leads to pain, functional impairment, social stigma, and reduced quality of life.
• Nail psoriasis is a risk factor for psoriatic arthritis (PsA).

Purpose of the Study:

• To review current therapeutic options for nail psoriasis in adults and children.
• To discuss management strategies for varying disease severity.
• To highlight the need for simplified disease severity assessment.

Main Methods:

• Literature review of existing studies on nail psoriasis treatments.
• Analysis of therapeutic options including topical, systemic, and biologic agents.
• Discussion of treatment efficacy for patients with and without co-existing skin psoriasis or PsA.

Main Results:

• Topical treatments may benefit mild cases; systemic treatments are indicated for severe nail psoriasis.
• Anti-tumour necrosis factor (TNF)-α, anti-interleukin (IL)-17, and anti-IL-12/23 antibodies show high efficacy.
• General advice includes nail care, protective gloves, and emollients.

Conclusions:

• Nail psoriasis management is challenging but crucial due to its impact on quality of life and association with PsA.
• Biologic therapies targeting TNF-α, IL-17, and IL-12/23 are effective for moderate to severe nail psoriasis.
• Further research is needed for simplified clinical assessment tools and pediatric management guidelines.