Pediatric Psoriasis
John Y. M. Koo, Ethan C. Levin, Argentina Leon, Jashin J. Wu, Alice B. Gottlieb in Moderate to Severe Psoriasis, 2014
Psoriatic nail lesions can be difficult to treat because of the poor penetration of topical agents through the nail plate. Instillation of steroid preparations into the subproximal nail fold area can be successful, but nightly application of flurandrenolide-impregnated tape to the base of the nail for approximately six months yields better results and is not painful, in contrast to steroid injections. An alternative is topical tazarotene gel applied nightly to the base of the nail [80]. Parents must understand that response to therapy is measured in terms of months and that there is no instant gratification. For adolescents, the use of psoralen plus ultraviolet A (PUVA) in a hand/foot box has proven effective in many patients. Methotrexate or biologic therapy is the most effective means of treatment but only occasionally indicated for isolated nail changes. The development of nail psoriasis can be partially prevented by hydration of nails before trimming, keeping nails trimmed, avoidance of manipulation of the cuticles, and wearing shoes that fit properly.
Topical Products Applied to the Nail
Heather A.E. Benson, Michael S. Roberts, Vânia Rodrigues Leite-Silva, Kenneth A. Walters in Cosmetic Formulation, 2019
Nail psoriasis is known to affect millions of people all around the world (Jefferson and Rich, 2012). The nail matrix, nail bed and nail folds are commonly affected by psoriasis, where the severity ranges from mild to extremely erythrodermic forms. A psoriatic nail displays a broad spectrum of symptoms varying from loosening of the nail plate, common pitting, hemorrhages and discolouration in the nail bed. The major signs of nail psoriasis include yellow-red discolouring, small pits in nails, thickening of skin under the nail, loosening and crumbling of the nail, and eventually nail loss (Jefferson and Rich, 2012). Nail psoriasis if left untreated can lead to functional impairment.
Psoriasis
Nilton Di Chiacchio, Antonella Tosti in Therapies for Nail Disorders, 2020
Nail psoriasis is the clinical manifestation of cutaneous psoriasis in the nail. It has significant impact on the patient, both functionally and psychologically. Nail psoriatic signs are present in 7%–56% of patients with cutaneous psoriasis. However, the lifetime incidence may be as high as 80%–90%. The prevalence of nail psoriasis without skin involvement or arthritis ranges from 1% to 6%. Nail lesions may appear several years later than cutaneous lesions, which may explain the fact that nail psoriasis is observed less frequently in children.
Pharmacotherapeutic approaches for treating psoriasis in difficult-to-treat areas
Published in Expert Opinion on Pharmacotherapy, 2018
Dario Kivelevitch, Jillian Frieder, Ian Watson, So Yeon Paek, M. Alan Menter
Nail psoriasis is mostly a clinical diagnosis made in the context of existing psoriatic skin lesions. It is commonly seen in patients with psoriatic arthritis involving the distal interphalangeal joints [35]. The incidence may be as high as 78%, and even higher in patients with concomitant joint involvement [72]. The nail unit is composed of the hard nail plate and four epithelial structures: the proximal nail fold, nail matrix, nail bed, and the hyponychium. Pitting, crumbling, ridging, and discoloration of the lunula are associated with nail matrix pathology, whereas onycholysis, hyperkeratosis, hemorrhages, or ‘oil spots’ are seen when the nail bed is affected, both on the hands and the feet (Figure 3) [73]. Ruling out onychomycosis, especially with toenail involvement, is an important diagnostic step.
Safety of current systemic therapies for nail psoriasis
Published in Expert Opinion on Drug Safety, 2023
Jonathan K. Hwang, Shari R. Lipner
Nail psoriasis is a chronic inflammatory nail condition that may occur in isolation or in conjunction with psoriasis of the skin and/or joints [1]. Estimated nail involvement is up to 50% in patients with plaque psoriasis (PsO) and up to 80% in those with psoriatic arthritis (PsA) at any one time, with an overall lifetime incidence of 80–90% [2]. Nail symptoms may not always parallel that of cutaneous disease, with isolated nail involvement prevalent in 5–10% of all psoriasis patients [2]. Clinical manifestations of nail psoriasis include onycholysis, subungual hyperkeratosis, nail plate pitting, nail crumbling, salmon patches, leukonychia, and splinter hemorrhages [1,2]. Impact of nail psoriasis extends beyond esthetics, often resulting in negative impact on patient quality of life, including pain, functional impairment, and psychosocial concerns [3]. Prompt diagnosis and treatment of nail psoriasis is thus warranted, given its substantial disease burden as well as potential progression to PsA [4].
Secukinumab efficacy in the treatment of nail psoriasis: a case series
Published in Journal of Dermatological Treatment, 2018
Giuseppe Pistone, Rosario Gurreri, Giovanna Tilotta, Elena Castelli, Maria Rita Bongiorno
Nail involvement is not only a cosmetic problem but it also affects structure and function of nails, being often associated with significant pain. Uncomfortable use of hands has a negative psychological effect, may interfere with working ability, and impairs quality of life (QoL) (7). Nail psoriasis is typically difficult to treat compared with skin disease, although several treatment options are available. Moreover, response of nails to any currently used treatment is significantly slower than that of skin lesions. There are limited data on the efficacy of biological agents to treat this specific localization. Secukinumab is a fully human IgG1 monoclonal antibody that selectively binds and neutralizes IL-17A that was recently shown to be a key player in the pathogenesis of plaque psoriasis, and to be effective on nail localization (8–12). This article describes results obtained with secukinumab in patients eligible for systemic treatment of psoriasis who also had nail involvement.
Related Knowledge Centers
- Nail Disease
- Psoriasis
- Psoriatic Arthritis
- Beau'S Lines
- Onycholysis
- Grenz Rays
- Placebo
- Topical Medication
- Etanercept
- Golimumab