Therapeutics for Adult Nail Psoriasis and Nail Lichen Planus

A Guide for Clinicians

Danielle R. McClanahan; Joseph C. English III


Am J Clin Dermatol. 2018;19(4):559-584. 

In This Article

Abstract and Introduction


Nail psoriasis (NP) and nail lichen planus (NLP) can be limiting, stigmatizing and difficult to treat. Dermatologists commonly treat psoriasis and lichen planus but when associated onychodystrophy is present or is an isolated finding, some develop apprehension. The goal of this review is to develop therapeutic ladders to be used as a guide for the management of NP and NLP in everyday clinical practice. Evidence-based therapies for NP are robust and range from topical treatments to conventional systemic therapies (i.e., methotrexate, cyclosporine), new oral agents (i.e., apremilast and tofacitinib), and biologics. The literature for treatment of NLP is severely limited, with therapy mainly consisting of topical, intralesional, or systemic corticosteroids or methotrexate.


Inflammatory nail diseases most commonly encountered by the dermatologist include nail psoriasis (NP) and nail lichen planus (NLP). This article reviews the current evidence-based therapies and recommends therapeutic ladders to manage isolated NP/NLP onychodystrophy or nail disease that is concurrent with cutaneous involvement.