Section Editor Prof. Dr. Jan C. Simon, Leipzig
Nail psoriasis – a treatment challenge
Article first published online: 20 FEB 2013
© The Authors | Journal compilation © Blackwell Verlag GmbH, Berlin
JDDG: Journal der Deutschen Dermatologischen Gesellschaft
Volume 11, Issue 3, pages 203–220, March 2013
How to Cite
Radtke, M. A., Beikert, F. C. and Augustin, M. (2013), Nail psoriasis – a treatment challenge. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 11: 203–220. doi: 10.1111/ddg.12054
Conflicts of interest Support for clinical studies, research on health services, and guest speaker fees provided by Abbott, Pfizer, MSD, Janssen, Biogen idec, Leo Pharma.
A 2010 study published in Germany on 3,531 psoriasis patients reported that 41% had nail involvement.
Other sources report a lifetime incidence of nail psoriasis among psoriasis patients of 80–90%.
Nail pitting occurs as a result of abnormal keratinization with severe parakeratosis and an accumulation of nuclear remnants on the surface of the nail plate.
Psoriatic ìoil spotsî caused by parakeratotic changes in the nail bed.
Subungual hyperkeratosis is hyperproliferation of the nail bed due to a psoriatic lesion at the affected site.
HLA-CW*0602 allele has the strongest association to the disease.
Systemic therapy should also be favored if there is concomitant joint involvement (psoriatic arthritis).
The fundamental challenge for topical therapy arises from the fact that the antipsoriatic agents can only very slowly penetrate into the nail plate – or not at all.
Intralesional steroid injections are a traditional form of treatment which offer safe and effective treatment of nail psoriasis, especially if the nail matrix is involved.
Fumaric acid esters
Measures to protect the nails can be an important part of treatment success
- Issue published online: 20 FEB 2013
- Article first published online: 20 FEB 2013
- Submitted: 12.6.2012 Accepted: 10.1.2013
Nail involvement in psoriasis is common and mostly occurs with other lesions but can also occur alone. Besides psychosocial and aesthetic impairments, patients often complain about functional impairment. Nail psoriasis is a predictor for more severe psoriasis, decreased quality of life, and a higher risk for the development of psoriatic arthritis. Onychomycosis and other differential diagnoses should be excluded prior to treatment. This article presents an overview of different clinical appearances of nail psoriasis, the essential diagnostic assessment before treatment, important differential diagnoses, and published data on treatment options for nail psoriasis.