Nail psoriasis: a retrospective study on the effectiveness of systemic treatments (classical and biological therapy)

• Published in: Journal of the European Academy of Dermatology and Venereology Vol. 25; no. 5; pp. 579 - 586
• Main Authors: Sánchez-Regaña, M, Sola-Ortigosa, J, Alsina-Gibert, M, Vidal-Fernández, M, Umbert-Millet, P
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-05-2011
• Subjects: Adalimumab; Age; Aged; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; biological therapy; Biological Therapy - adverse effects; CD11 antigen; Cyclosporine - adverse effects; Cyclosporine - therapeutic use; Cyclosporins; Dermatologic Agents - adverse effects; Dermatologic Agents - therapeutic use; etanercept; Female; Fingernail; Humans; Infliximab; Male; Methotrexate; Middle Aged; Monoclonal antibodies; Nail Diseases - drug therapy; Nail Diseases - therapy; nail psoriasis; Psoriasis; Psoriasis - drug therapy; Psoriasis - therapy; Retrospective Studies; Severity of Illness Index; Skin diseases; systemic treatment; Time Factors; treatment; Treatment Outcome; Tumor necrosis factor- alpha
• ISSN: 0926-9959; 1468-3083
• DOI: 10.1111/j.1468-3083.2010.03938.x

Background  Nail psoriasis represents a challenge for specialists. There is no comparative study of systemic treatment’s effectiveness at this site. Objective: Evaluate the response of nail psoriasis to classical and biological therapy and to compare the effectiveness and safety of the different treatments.
Methods  We performed a retrospective study of 84 patients with moderate–severe psoriasis seen at our Department between January 2006 and January 2009.
Results  Psoriasis was severe in 53.4%. In 75% of cases, the fingernails were affected, and the mixed form was the most frequently subtype. The mean baseline scores on the PASI and the NAPSI were 23.12 and 14.7 respectively; the correlation between the two scores fell at weeks 12 and 24 but had risen again at week 48. The baseline NAPSI score tended to be lower in women and significantly higher in patients over 65 years of age, family history of psoriasis, severe psoriasis and nail matrix involvement. In our series, 58.3% received classical treatment (acitretin, methotrexate, cyclosporin, PUVA, NUVB, REPUVA, RENUVB) and 41.7% received biological treatment (infliximab, efalizumab, etanercept, adalimumab).Significant reductions were found (P < 0.05) in the mean NAPSI scores at 12, 24 and 48 weeks with all the antipsoriatic agents except NUVB; significantly greater with cyclosporine (P < 0.01) and biological as infliximab and adalimumab at 12 and 24 weeks (differences between treatments disappeared at 48 weeks).
Conclusion  The response to treatment is slower in the nail lesions than in the skin lesions. The improvement of nail psoriasis is significant both with the classical treatments significantly higher in cyclosporin; and biological treatment (infliximab and adalimumab at 12 and 24 weeks).