What is the role of systemic therapies in the treatment of nail psoriasis?

Updated: Jun 25, 2021
  • Author: Cindy Li, DO; Chief Editor: William D James, MD  more...
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Systemic therapies have been used in patients with severe cutaneous psoriasis. Few studies have shown significant improvement in nail psoriasis with long-term results.

Three systemic medications are most commonly used for psoriasis and nail psoriasis: methotrexate, retinoids, [21] and cyclosporine. [22]  All three agents have potential serious adverse effects and toxicities. In most cases, the psoriatic nail disease recurs after the systemic therapy is stopped. Carefully weigh the risk-to-benefit ratio in the treatment of nail psoriasis. Systemic therapies are seldom a first-line therapy for nail psoriasis. Topical treatment with calcipotriol can be used as adjunctive therapy and maintenance therapy with systemic treatment. Biological therapy for psoriasis and psoriatic arthritis may have a significant benefit for some patients with psoriatic nail disease. [23]

In 2017, the US Food and Drug Administration (FDA) approved the addition of moderate-to-severe fingernail psoriasis data to the adalimumab prescribing information, based on results from a phase 3, multicenter, randomized, double-blind, parallel-arm, placebo-controlled clinical trial. [24]

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