Interventions for nail psoriasis

There is not sufficiently information to determine the effectiveness of topical treatments for nail proriasis. Systemic therapies and radiotherapies may be effective.

Comment: The quality of evidence is downgraded by study limitations (lack of blinding, selective reporting) and imprecise results (few patients).

Summary

A Cochrane review included 18 studies with a total of 1 266 participants comparing various interventions to placebo in individuals with psoriasis with nail involvement. Ten studies assessed topical treatments such as clobetasol, ciclosporin in maize oil, hyaluronic acid with chondroitin sulphates, 5-fluorouracil, a combination of dithranol with salicylic and UVB, tazarotene, and calcipotriol); five studies assessed systemic treatments such as golimumab, infliximab, ustekinumab, ciclosporin, and methotrexate; and three studies assessed radiotherapy such as electron beam, grenz ray, and superficial radiotherapy.

In 5 studies there was significant improvement of nail psoriasis compared to placebo: with infliximab (5 mg/kg), golimumab (50 mg and 100 mg), superficial radiotherapy, electron beam, and grenz rays. This review reported only mild adverse effects, recorded mainly for systemic treatments

Clinical comments

Systemic therapies are usually not used for treating nails alone; they are used for cutaneous psoriasis or psoriatic arthritis. They can be used if the nail psoriasis is severe, refractory to other treatments, and has a major impact on the person's quality of life. Radiotherapy is not used for psoriasis in common practice.

Note

Date of latest search: 22.03.2012

Ədəbiyyat

1. de Vries AC, Bogaards NA, Hooft L et al. Interventions for nail psoriasis. Cochrane Database Syst Rev 2013;1():CD007633.