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Objectives To assess the frequency of simultaneous distal interphalangeal (DIP) joint disease and adjacent nail psoriasis (finger unit) among patients with psoriatic arthritis (PsA) and compare the efficacy of the IL-17A antagonist ixekizumab (IXE) and the TNF-α inhibitor adalimumab (ADA). Methods This post hoc analysis evaluated the simultaneous occurrence of DIP joint involvement (tenderness and/or swelling) and adjacent nail psoriasis among patients with PsA from the SPIRIT-H2H (NCT03151551) trial comparing IXE to ADA. Among patients with simultaneous DIP joint involvement and adjacent nail psoriasis in ≥1 digit at baseline, treatment effects were assessed through week 52 for each affected finger unit; 'finger unit' defines the connected DIP joint and adjacent nail of an individual digit. Results A total of 354 patients had simultaneous DIP joint involvement and adjacent nail psoriasis in ≥1 finger unit at baseline. Among them, 1309 (IXE: 639; ADA: 670) finger units had baseline DIP joint tenderness and/or swelling and adjacent nail psoriasis. Proportions of affected finger units achieving complete resolution were significantly higher with IXE vs ADA as early as week 12 (38.8% vs 28.4%, P  < 0.0001) and at all post-baseline assessments through week 52 (64.9% vs 57.5%, P  = 0.0055). Conclusion In this study cohort, patients with DIP joint involvement almost always had adjacent nail psoriasis. Greater resolution of DIP joint tenderness, swelling and adjacent nail psoriasis was achieved at all time points over 52 weeks through targeting IL-17A with IXE than TNF-α with ADA, which is noteworthy given prior comparable musculoskeletal outcomes for both drug classes. [ABSTRACT FROM AUTHOR]

This systematic review assesses the evidence concerning laser treatments for nail psoriasis (NP), a prevalent condition among individuals with cutaneous psoriasis that notably affects their quality of life. Traditional treatments have limitations in terms of drug delivery and poor patient adherence, leading to interest in laser therapies for their targeted approach, extended treatment intervals, and the potential to enhance topical medication effectiveness. The MEDLINE, Embase, Web of Science, and Cochrane Library databases were searched. English‐language randomized and non‐randomized controlled trials with full‐text availability were included. Data on the laser type, treatment protocol, Nail Psoriasis Severity Index (NAPSI) outcomes, and adverse events were extracted, and nail bed and matrix features and patient satisfaction were assessed. The primary effect measure was a percentage reduction in NAPSI scores from baseline. Nineteen studies involving the pulse dye laser (PDL), long‐pulsed neodymium:yttrium aluminum garnet (Nd:YAG) laser and fractional carbon dioxide laser (FCL) were identified. Lasers, particularly those used in conjunction with topical agents, have shown favorable results. PDL effectively lowered NAPSI scores, and the Nd:YAG laser had comparable effectiveness but more discomfort. FCL also shows promise, particularly for topical drug delivery. PDL and Nd:YAG laser treatment were more effective at reducing nail bed features, whereas FCL was effective at reducing both nail bed and matrix features. Overall, lasers are promising treatment alternatives for NP, with similar NAPSI outcomes to topical therapies and intralesional injections. [ABSTRACT FROM AUTHOR]

Recent studies have shown that local injection of secukinumab can achieve positive therapeutic effects when applied in the treatment of nail psoriasis. At present, there have been no other studies on the use of biological agents in the treatment of pediatric nail psoriasis. Three children were included in the study to evaluate the efficacy and safety of periungual injection and long-term injection of secukinumab in the treatment of nail psoriasis in children. It was found that local injection did not achieve a remarkable therapeutic effect. The nail lesions were improved continuously by subcutaneous injection once a month. [ABSTRACT FROM AUTHOR]

A literature search on the subject of botulinum toxin treatment in psoriasis found 15 relevant articles, 11 on human subjects and 4 on animal studies. Of the human data, eight were clinical trials and three were single case reports. Seven out of eight clinical trials, all open-label, reported improvement in psoriasis following intradermal or subcutaneous botulinum toxin injections. One double-blind, placebo-controlled study, which used a smaller dose than the open-label studies, did not note a healing effect. Animal studies have shown that injection of botulinum toxins in the skin heals psoriatic skin lesions and can reduce the level of interleukins (ILs) and cytokines as well as inflammatory cells in psoriatic plaques. There is a need for controlled, blinded studies conducted in larger numbers of patients with doses that have shown promise in open-label studies. [ABSTRACT FROM AUTHOR]

(1) Background/Objectives: Nail psoriasis (NP) is a chronic and difficult-to-treat disease, which causes significant social stigma and impairs the patients' quality of life. Moreover, nail psoriasis is a true therapeutic challenge for clinicians. The presence of nail psoriasis can be part of a severe form of psoriasis and can have predictive value for the development of psoriatic arthritis. Our real-world-evidence multicenter study aims to evaluate the efficacy of bimekizumab in nail psoriasis. (2) Methods: A retrospective analysis of a multicenter observational study included 834 patients affected by moderate-to-severe psoriasis, in 33 Dermatologic Units in Italy, treated with bimekizumab from December 2022 to September 2023. Clinimetric assessments were based on Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), and Physician's Global Assessment of Fingernail Psoriasis (PGA-F) for the severity of nail psoriasis at 0, 12, 24, and 36 weeks. (3) Results: Psoriatic nail involvement was present in 27.95% of patients. The percentage of patients who achieved a complete clearance of NP in terms of PGA-F 0 was 31.7%, 57%, and 88.5% at week 4, 16, and 36, respectively. PASI 100 was achieved by 32.03% of patients at week 4, by 61.8% at week 16, and by 78.92% of patients at week 36. The mean baseline PASI was 16.24. The mean DLQI values for the entire group of patients at baseline, at week 4, at week 16, and at week 36 were 14.62, 3.02, 0.83, and 0.5, respectively. (4) Conclusions: Therapies that promote the healing of both the skin and nails in a short time can also ensure a lower risk of subsequently developing arthritis which is disabling over time. Bimekizumab proved to be particularly effective to treat NP, with a fast response in terms of complete clearance, with over 88.5% of patients free from NP after 36 weeks. The findings of our real-world study showed that patients with moderate-to-severe PsO and concomitant NP had significantly faster and more substantial improvements in NP up to 36 weeks with respect to previous research findings. Considering the rapid healing of the nail, the dual inhibition of IL17 A and F might have a great value in re-establishing the dysregulation of keratin 17 at the nail level. [ABSTRACT FROM AUTHOR]

Nail psoriasis is a chronic, inflammatory condition which is difficult to treat, linked with greater psoriasis severity, and may be associated with anxiety and significant functional impairment of the quality of life. The 1064 nm Nd: YAG laser was reported to yield satisfactory results in the treatment of nail psoriasis. The aim of the study was to assess the clinical and ultrasonographic efficacy of long-pulsed 1064 nm Nd: YAG laser in the treatment of fingernail psoriasis and compare its effect to control fingernails. This intra-patient randomized controlled trial analyzed 86 fingernails collected from 13 patients suffering from cutaneous and nail psoriasis. The nails were randomized into two groups. Group A was treated with Nd: YAG laser once monthly for three sessions while group B served as control. Assessment took place at baseline, 1 and 3 months after the last treatment session. For scoring, the 32-points target NAPSI scoring systems was used. Additionally, two blinded dermatologists' score of improvement, patients' pain assessment by visual analogue score and ultrasonographic assessment were all performed. At the end of follow up, the medians of tNAPSI score, plate definition, matrix thickness, bed thickness and bed vascularity decreased significantly in the Nd: YAG laser treated group in comparison to baseline (p = 0.001, 0.006, 0.039, < 0.001 and 0.010, respectively). While, there was a non-significant reduction in median tNAPSI score in the control group at last follow up, however, ultrasonography recorded a significant reduction in the medians of plate definition, bed thickness and vascularity (p = 0.002, 0.011 and 0.033, respectively) from the baseline. Comparison of the Nd: YAG laser and the control groups showed no significant difference from baseline regarding the medians of tNAPSI, tNAPSI percentile improvement, pits count, blinded evaluation of photographs and ultrasonographic assessments. In conclusion, Nd: YAG laser showed clinical and ultrasonographic improvement in fingernail psoriasis. Ultrasonography is a useful noninvasive tool in diagnosing and monitoring the clinical and even the subclinical changes in nail psoriasis. Nail psoriasis although difficult to treat, may show spontaneous improvement. [ABSTRACT FROM AUTHOR]

Background: Nail psoriasis remains a challenging condition with limited satisfaction from current treatments. An increasing number of neuropeptides were reported in psoriatic tissue. Objective: To compare the efficacy of botulinum toxin A (BoNT-A) injection, triamcinolone acetonide (TA) injection, topical combination of vitamin D/steroid (VitD/steroid) and placebo in improving nail psoriasis. Methods: A 24-week randomized intraindividual comparative-controlled study involved participants with at least 4 psoriatic fingernails, each with a total target nail psoriasis severity index (NAPSI) score of at least 3 points. Nails were randomly received different treatments; intralesional BoNT-A injection at baseline, intralesional TA at baseline and eighth week, daily topical VitD/steroid application for 16 weeks and placebo. Results: Evaluation of 64 psoriatic fingernails showed a 40% reduction in the total target NAPSI score at 24 weeks following BoNT-A injection (P = .001). BoNT-A significantly improved nail bed lesions more than TA and topical VitD/steroid (P = .038), with no reported serious adverse effects. Limitations: Relatively small sample size; hand hygiene during the COVID-19 pandemic may interfere NAPSI score evaluation. Conclusions: BoNT-A injection emerges as a promising and effective therapy for nail psoriasis, providing sustained efficacy lasting up to 6 months with a single injection.

Introduction: Nail psoriasis is common in psoriasis vulgaris and even more prevalent in psoriatic arthritis. Dermatoscopy of the nail proves helpful in enhancing the visualization of psoriatic nail lesions. Objective: This systematic review aimed to summarize the existing studies published in the literature that reported the various dermoscopic features of nail psoriasis. Materials and methods: A systematic search of two medical databases, PubMed and Scopus, was conducted in April 2023. In total, 11 records were included. The number of reported cases in the included studies was 723. Results: The average age was 42.39 years. Sixty percent of patients were males, and 40% were females. Pitting constituted the most common onychoscopic feature indicating nail matrix involvement, followed by various other features such as leukonychia, nail plate thickening, transverse and longitudinal ridges, and different lunula abnormalities. The predominant onychoscopic feature indicating nail bed involvement was onycholysis, followed by splinter hemorrhages, oil drop sign, subungual hyperkeratosis, dilated capillaries, agminated capillary dots, erythematous border, and pustules. Vascular abnormalities observed in all locations were present in 52% of patients. Conclusions: The clinical signs of nail psoriasis are diverse, and for the majority, they are nonspecific. Nail dermoscopy is a noninvasive tool that enhances the visualization of the nail manifestations of psoriasis. It may facilitate the establishment of diagnostic criteria for this pathology without resorting to more invasive procedures, such as nail biopsy. [ABSTRACT FROM AUTHOR]

Introduction: Dermatological conditions affecting the nails can manifest differently in individuals with distinct skin tones. This often leads to difficulty in the recognition of nail diseases especially in people with skin of color (SoC), that result not well represented in the literature. Objectives: Our aim was to provide dermatologists with useful clues for prompt recognition and diagnosis of nail psoriasis (NPso) and nail lichen planus (NLP) in people with SoC. Methods: We described the ungual manifestations of NPso and NLP in a population of 30 patients with SoC. Diagnosis was primarily based on clinical examination; in cases of diagnostic uncertainty, a biopsy of the nail matrix was performed to obtain histological conclusive evidence. Results: Of the 30 people with SoC in the analysis, 24 patients had NPso with a median Fitzpatrick phototype of 4.77 and 6 patients had NLP with a median Fitzpatrick phototype of 5. Regarding the 24 patients with NPso, 10 presented with trachyonychia, 9 displayed nail pitting, 8 showed onycholysis, 12 had subungual hyperkeratosis, while splinter hemorrhages were visible in 2 patients and activation melanonychia was discernible on the nail plates of 8 patients. Over the 6 patients diagnosed with NLP, all of them had post-inflammatory pigmentation on the proximal nail, with 3 patients exhibiting trachyonychia and 3 others having longitudinal fissures; subungual hyperkeratosis was found in 5 patients, while 3 patients displayed activated melanonychia. Conclusion: People with SoC exhibit a peculiar clinical presentation of both NPso and NLP and a better understanding is essential for providing timely and effective care.

Despite the abundance of data concerning biologic treatments for patients with psoriasis, clinicians are often challenged with discerning the optimal treatment for each patient. To inform this selection, this study explored whether a patient’s baseline characteristics or disease profile could predict the likelihood of achieving complete skin clearance with biologic treatment. Machine-learning and other statistical methods were applied to the substantial data collected from patients with moderate-to-severe psoriasis in the ongoing, international, prospective, observational Psoriasis Study of Health Outcomes (PSoHO). The 3 measures of complete skin clearance were a psoriasis area and severity index (PASI)100 response at (a) week 12, (b) month 12, and (c) week 12 and maintain ed at month 6 and month 12 (PASI100 durability). From these real-world data, the absence of nail psoriasis emerged as the most consistent feature that may be used by clinicians to predict high-level treatment responses with biologic treatment. Other significant predictors of skin clearance with biologic treatments were the absence of hypertension and a lower body surface area affected by psoriasis. Overall, this study evidences the substantial challenge of identifying reliable clinical markers of treatment response for patients with psoriasis and highlights the importance of regular screening for psoriatic nail involvement.

Abstract Introduction Since during the COVID-19 pandemic nail psoriasis was evaluated exclusively with teledermatology, dermatologists started to face the difficulty in rating it concurrent with other onycopathies (i.e., onychotillomania and onychophagy). Thus, we aimed to improve the existing severity scores and verify the value in different clinical settings (i.e., in person vs. teledermatology (video or picture)). Methods This multicenter prospective observational study evaluated patients with nail psoriasis and screened them for onychophagy or onychotillomania in telemedicine from May 2020 to January 2021. For therapeutic purposes patients with nail psoriasis were followed and rated with the Nijmegen-Nail psoriasis Activity Index tooL (N-NAIL) for 9 months; at the same time, N-NAIL and a new dedicated index that monitor also the changes in nail dimension (Galeazzi-(G) N-NAIL) were tested for accuracy. We assessed inter- and intraobserver agreement for the three different settings (in person, video, and pictures). Results In our cohort of 382 patients with nail psoriasis after a clinical and dermatoscopic assessment we found 20 (5.24%) patients with onychophagy and 17 (4.45%) patients with onychotillomania. Analysis of the impact of nail psoriasis on patients revealed that onycholysis and crumbing, followed by subungual hyperkeratosis, were the clinical signs that prevalently bothered patients. N-NAIL score displayed moderate intra- and interobserver agreement. Over the 9 months follow-up, N-NAIL vs. GN-NAIL displayed a solid correlation at all the examined time points, i.e., baseline and after 3, 6, and 9 months. Conclusion We created a new tool, the GN-NAIL capable of efficiently scoring nail psoriasis severity in complex cases, such as patients with onychotillomania and onychophagy, and monitor response to treatment during the COVID-19 pandemic.

Background/Objectives: Nail psoriasis, a subtype of psoriasis, can cause significant pain, disability, and reduced quality of life. Despite the established efficacy of anti‐IL17 secukinumab in improving skin psoriasis, there is a lack of clinical trials focusing on nail psoriasis as primary endpoint. This study aims to investigate the efficacy of secukinumab in treating nail psoriasis in patients with moderate to severe psoriasis. Methods: We prospectively recruited patients newly diagnosed with moderate to severe psoriasis in single centre from January 2021 to January 2022 who were treated with secukinumab. Results: A total of 16 patients consisting of 9 males and 7 females were included. Their mean age was 38.88 ± 10.29 years. They had an average initial Nail Psoriasis Severity Index (NAPSI) score of 45.06 ± 20.39 and an average NAPSI score at 12 weeks of 8.94 ± 13.50, showing a significant (p < 0.05) decrease of NAPSI score after 12 weeks of secukinumab treatment. After 24 weeks of treatment, NAPSI score was decreased to 5.12 ± 8.52. Conclusion: Secukinumab rapidly improved nail psoriasis after 12 weeks of treatment, with further enhancement at 24 weeks, suggesting its potential as a potent therapeutic option for nail psoriasis. [ABSTRACT FROM AUTHOR]

Introduction: Since during the COVID-19 pandemic nail psoriasis was evaluated exclusively with teledermatology, dermatologists started to face the difficulty in rating it concurrent with other onycopathies (i.e., onychotillomania and onychophagy). Thus, we aimed to improve the existing severity scores and verify the value in different clinical settings (i.e., in person vs. teledermatology (video or picture)). Methods: This multicenter prospective observational study evaluated patients with nail psoriasis and screened them for onychophagy or onychotillomania in telemedicine from May 2020 to January 2021. For therapeutic purposes patients with nail psoriasis were followed and rated with the Nijmegen-Nail psoriasis Activity Index tooL (N-NAIL) for 9 months; at the same time, N-NAIL and a new dedicated index that monitor also the changes in nail dimension (Galeazzi-(G) N-NAIL) were tested for accuracy. We assessed inter- and intraobserver agreement for the three different settings (in person, video, and pictures). Results: In our cohort of 382 patients with nail psoriasis after a clinical and dermatoscopic assessment we found 20 (5.24%) patients with onychophagy and 17 (4.45%) patients with onychotillomania. Analysis of the impact of nail psoriasis on patients revealed that onycholysis and crumbing, followed by subungual hyperkeratosis, were the clinical signs that prevalently bothered patients. N-NAIL score displayed moderate intra- and interobserver agreement. Over the 9 months follow-up, N-NAIL vs. GN-NAIL displayed a solid correlation at all the examined time points, i.e., baseline and after 3, 6, and 9 months. Conclusion: We created a new tool, the GN-NAIL capable of efficiently scoring nail psoriasis severity in complex cases, such as patients with onychotillomania and onychophagy, and monitor response to treatment during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

(1) Background/Objectives: Nail psoriasis (NP) is a chronic and difficult-to-treat disease, which causes significant social stigma and impairs the patients’ quality of life. Moreover, nail psoriasis is a true therapeutic challenge for clinicians. The presence of nail psoriasis can be part of a severe form of psoriasis and can have predictive value for the development of psoriatic arthritis. Our real-world-evidence multicenter study aims to evaluate the efficacy of bimekizumab in nail psoriasis. (2) Methods: A retrospective analysis of a multicenter observational study included 834 patients affected by moderate-to-severe psoriasis, in 33 Dermatologic Units in Italy, treated with bimekizumab from December 2022 to September 2023. Clinimetric assessments were based on Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), and Physician’s Global Assessment of Fingernail Psoriasis (PGA-F) for the severity of nail psoriasis at 0, 12, 24, and 36 weeks. (3) Results: Psoriatic nail involvement was present in 27.95% of patients. The percentage of patients who achieved a complete clearance of NP in terms of PGA-F 0 was 31.7%, 57%, and 88.5% at week 4, 16, and 36, respectively. PASI 100 was achieved by 32.03% of patients at week 4, by 61.8% at week 16, and by 78.92% of patients at week 36. The mean baseline PASI was 16.24. The mean DLQI values for the entire group of patients at baseline, at week 4, at week 16, and at week 36 were 14.62, 3.02, 0.83, and 0.5, respectively. (4) Conclusions: Therapies that promote the healing of both the skin and nails in a short time can also ensure a lower risk of subsequently developing arthritis which is disabling over time. Bimekizumab proved to be particularly effective to treat NP, with a fast response in terms of complete clearance, with over 88.5% of patients free from NP after 36 weeks. The findings of our real-world study showed that patients with moderate-to-severe PsO and concomitant NP had significantly faster and more substantial improvements in NP up to 36 weeks with respect to previous research findings. Considering the rapid healing of the nail, the dual inhibition of IL17 A and F might have a great value in re-establishing the dysregulation of keratin 17 at the nail level.

A literature search on the subject of botulinum toxin treatment in psoriasis found 15 relevant articles, 11 on human subjects and 4 on animal studies. Of the human data, eight were clinical trials and three were single case reports. Seven out of eight clinical trials, all open-label, reported improvement in psoriasis following intradermal or subcutaneous botulinum toxin injections. One double-blind, placebo-controlled study, which used a smaller dose than the open-label studies, did not note a healing effect. Animal studies have shown that injection of botulinum toxins in the skin heals psoriatic skin lesions and can reduce the level of interleukins (ILs) and cytokines as well as inflammatory cells in psoriatic plaques. There is a need for controlled, blinded studies conducted in larger numbers of patients with doses that have shown promise in open-label studies.

The purpose of this review is to consolidate and summarize laser-assisted drug delivery (LADD) for nail diseases, particularly onychomycosis and psoriasis. A PubMed search was conducted in June 2023 using search terms (1) "laser assisted drug delivery" AND "nail," (2) "laser" AND "nail," and (3) "nail disorder" AND "laser treatment." References of papers were also reviewed, yielding 15 papers for this review. Fractional ablative CO2 laser (FACL) and Er:YAG laser can be used for LADD of topical medications such as amorolfine, terbinafine, and tioconazole to treat onychomycosis. A fungal culture should be performed to determine the type of dermatophyte, which will help determine which topical will be most effective. Laser settings varied between studies, but overall LADD tended to be more effective than topical treatments alone. Laser-assisted photodynamic therapy (PDT) was also found to be effective in treating onychomycosis. For psoriatic nails, LADD was used to deliver calcipotriol-betamethasone dipropionate foam, tazarotene, triamcinolone, or methotrexate into the nail. Again, LADD was found to be significantly more effective than topical treatment alone. FACL was the only laser noted for use for LADD in both diseases. Laser-assisted drug delivery for nail disease is a newer approach for onychomycosis and nail psoriasis with several benefits and drawbacks. Dermatologists should discuss the option of LADD with their patients who have recalcitrant onychomycosis or nail psoriasis. [ABSTRACT FROM AUTHOR]

Introducion: Psoriasis is a chronic inflammatory skin disease that can affect many parts of the body. Psoriatic involvement of the nail bed or nail matrix results in nail psoriasis that is common. Patients with psoriatic nails have impaired quality of life due to the appearance of nails, and significant morbidity and functional impairments may arise in large cases. The management of nail psoriasis is challenging because it is usually time-consuming with unsure outcomes. The existing evidences suggest that intralesional injection are particularly effective for nail psoriasis. Current studies provide recommendations on the intralesional injection technique, recommending an optimal concentration of methotrexate (MTX), triamcinolone acetonide (TA), and cyclosporine but the comparison of these treatment was still limited. Objective: This study aimed to evaluate the efficacy of intralesional injections of MTX compared with TA in treating nail psoriasis using Nail Psoriasis Severity Index (NAPSI) score. Methods: A systematic literature search was performed using EBSCOhost, Scopus, ProQuest, ScienceDirect, SpringerLink, Elsevier Clinical Key, Cochrane library, ClinicalTrials.gov subgroups terms: “intralesional methotrexate injections for nail psoriasis”, “intralesional triamcinolone acetonide injections for nail psoriasis” and “NAPSI Score”. Three studies were included in the qualitative synthesis and meta-analysis. Results: The overall SMD in NAPSI scores after administration of intralesional injection of MTX and TA was -0.213±0.232 (95% CI = -0.667 to 0.241). The Q statistic value was -0.921 (p=0.357), indicating the insignificant difference in the effectiveness of both therapies. Conclusion: Both MTX and TA were effective in treating nail psoriasis based on the reduction of NAPSI score.

Abstract Introduction The aim of this study was to evaluate guselkumab efficacy on regional psoriasis in a subset of psoriasis patients with a self-reported psoriatic arthritis (PsA) diagnosis. Methods In the phase 3 VOYAGE-1 and -2 studies, at week (W)0, patients with moderate-to-severe psoriasis were randomized to guselkumab 100 mg, placebo → guselkumab 100 mg at W16 through W44, or adalimumab 80 mg then 40 mg at W1 through W48 (VOYAGE-1) or W24 (VOYAGE-2). Pooled efficacy outcomes, including scalp-specific Investigator’s Global Assessment (ss-IGA), hands and/or feet Physician’s Global Assessment (hf-PGA), fingernail PGA (f-PGA), Nail Psoriasis Area and Severity Index (NAPSI), and Dermatology Life Quality Index (DLQI), were compared (nominal p-values) through W24 in patients with self-reported PsA diagnosis. Response rates/percentage improvement from baseline were determined, employing treatment failure rules and non-response/no improvement data imputation. Results A total of 76, 153, and 106 psoriasis patients with self-reported PsA were randomized to the placebo, guselkumab, or adalimumab groups, respectively; the baseline characteristics of patients in all three arms were comparable. At W16, a greater proportion of guselkumab- versus placebo-treated patients achieved ss-IGA 0/1 (80.6% vs. 22.7%, p

Abstract Background Nail psoriasis is a common, physiologically, and psychologically disruptive, and yet often under-treated manifestation of psoriasis. The objectives of this analysis were to investigate the trajectory of nail psoriasis, a risk factor for psoriatic arthritis (PsA), with guselkumab vs adalimumab treatment followed by withdrawal, and determine characteristics associated with nail response in patients treated with guselkumab. Methods This post hoc analysis of the phase III trial VOYAGE 2 included patients with moderate-to-severe plaque psoriasis and baseline nail involvement. Nail Psoriasis Severity Index (NAPSI) and Psoriasis Area and Severity Index (PASI) were analyzed through week 48 in patients randomized to guselkumab or adalimumab. Multiple logistic regression analyzed factors associated with NAPSI 0/1 at week 24/week 48 following guselkumab treatment. In a separate analysis, patients were stratified by prior biologic experience. Results Overall, 272 vs 132 patients receiving guselkumab vs adalimumab had nail psoriasis at baseline. Lower baseline NAPSI and week 16 PASI were associated with achieving NAPSI 0/1 at week 24 (NAPSI, odds ratio 0.685 [95% confidence interval: 0.586, 0.802]; week 16 PASI, 0.469 [0.281, 0.782]) and week 48 (NAPSI, 0.784 [0.674, 0.914]; week 16 PASI, 0.557 [0.331, 0.937]) with guselkumab. Previous biologic experience did not impact NAPSI response. Following treatment withdrawal at week 28, mean NAPSI was maintained in the guselkumab arm (week 24 1.7, week 48 1.9) and increased slightly in the adalimumab arm (week 24 1.4, week 48 2.3). Mean PASI increased across both treatment arms. Conclusions Higher skin efficacy at week 16 was associated with better nail responses during guselkumab treatment. Nail psoriasis improvements reflected skin improvements. Following guselkumab withdrawal, nail response was maintained longer than skin response. Future studies should investigate whether such improvements in nail response reduce patients’ risk of later PsA development. Trial registration ClinicalTrials.gov, NCT02207244. Registered July 31, 2014.

Abstract Nail psoriasis is a difficult-to-treat manifestation of psoriatic disease affecting up to 80% of patients with psoriatic arthritis (PsA) and 40–60% of patients with plaque psoriasis (PsO). Ixekizumab (IXE), a high-affinity monoclonal antibody that selectively targets interleukin-17A, is approved for the treatment of patients with PsA and patients with moderate-to-severe PsO. This narrative review aims to summarize nail psoriasis data generated from IXE clinical trials in patients with PsA (SPIRIT-P1, SPIRIT-P2, and SPIRIT-H2H) and/or moderate-to-severe PsO (UNCOVER-1, -2, -3, IXORA-R, IXORA-S, and IXORA-PEDS) with an emphasis on head-to-head clinical trial data. Across numerous trials explored, IXE treatment was associated with greater improvement in resolution of nail disease versus comparators at week 24, results which were maintained up to and beyond week 52. Additionally, patients experienced higher rates of resolution of nail disease versus comparators at week 24 and maintained high levels of resolution up to week 52 and beyond. In both PsA and PsO, IXE demonstrated efficacy in treating nail psoriasis, and therefore may be an effective therapy option. Trial Registration: ClinicalTrials.gov identifier UNCOVER-1 (NCT01474512), UNCOVER-2 (NCT01597245), UNCOVER-3 (NCT01646177), IXORA-PEDS (NCT03073200), IXORA-S (NCT02561806), IXORA-R (NCT03573323), SPIRIT-P1 (NCT01695239), SPIRIT-P2 (NCT02349295), SPIRIT-H2H (NCT03151551).

Teresa Battista, Massimiliano Scalvenzi,&ast; Fabrizio Martora,&ast; Luca Potestio, Matteo Megna Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy&ast;These authors contributed equally to this workCorrespondence: Fabrizio Martora, Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, Napoli, 80131, Italy, Tel +39 - 81 – 7462457, Fax +39 - 81 – 7462442, Email fabriziomartora92@libero.itBackground: Nail psoriasis (NP) has a prevalence that ranges from 10 to 82% among patients with psoriasis (PsO) and is one of the most common difficult to treat site of psoriasis. We performed a thorough review of the literature, exploring evidence regarding all available NP systemic treatments, describing also in detail NP dedicated clinical trials.Methods: A literature search was conducted in PubMed and Embase prior to February 2023 using a combination of the terms “nail” AND “psoriasis” AND “systemic therapy” AND/OR “systemic treatment”. A total of 47 original studies and case reports were reviewed in this article.Results: Systemic therapies should be considered when the disorder involves more than 3 nails, has extensive skin and joint involvement, and has a significant impact on QoL, due to their best long-term efficacy. In detail, conventional and biologic systemic drugs demonstrated efficacy in recent trials, including acitretin, methotrexate, cyclosporine, apremilast, adalimumab, infliximab, etanercept, certolizumab, golimumab, ustekinumab, secukinumab, ixekizumab, brodalumab, bimekizumab, guselkumab, risankizumab and tildrakizumab.Conclusion: Several therapies have demonstrated efficacy and safety in the treatment of NP; however, the choice of treatment depends not only on the severity of the nail involvement, but also on whether PsA is present, the patient’s comorbidities other than PsA, previous treatment history, and the patient’s drug preferences.Keywords: nail psoriasis, psoriasis, treatment, biologics

Background Available network meta-analyses (NMAs) comparing the efficacy of biologics in nail psoriasis (NP) have not included recently approved biologics such as bimekizumab nor have they provided comparisons up to 1 year. Objective We conducted two NMAs that update and extend results from a previous NMA comparing biologics for achieving complete resolution of NP. Methods Bayesian NMAs were performed using a generalized linear model with a logit link to model the binary outcome of nail clearance at weeks 24–28 and 48–52. Results For the NMA at weeks 24–28, which included seven biologics and placebo, the absolute probability of achieving complete resolution of NP was highest for ixekizumab (46.4%; 95% credibility interval [CrI] 35.2–58.0), followed by brodalumab (37.1%; 95% CrI 17.1–62.2) and bimekizumab (30.3%; 95% CrI 12.7–53.9). For the NMA at weeks 48–52, which included six biologics, the absolute probability was highest for ixekizumab (77.2%; 95% CrI 51.1–93.4), followed by adalimumab (75.6%; 95% CrI 61.5–87.3) and brodalumab (71.9%; 95% CrI 38.4–93.2). Conclusion Among biologics included in these two NMAs, ixekizumab has the highest absolute probability of achieving complete resolution of NP. Results may help to inform treatment decisions for patients with NP.

Background: Nail involvement in psoriasis is common and may be an indicator not only of disease severity, but also of the presence of psoriatic arthritis. However, the relationship of nail psoriasis with enthesitis remains under-explored. Aims: This study was conducted to evaluate the clinical, onychoscopic (nail dermatoscopic) and ultrasonographic features in patients with nail psoriasis. Materials and Methods: All nails of twenty adult patients with nail psoriasis were examined clinically and onychoscopically. Patients were evaluated for psoriatic arthritis (Classification Criteria for Psoriatic Arthritis), the severity of cutaneous disease (Psoriasis Area Severity Index) and nail disease (Nail Psoriasis Severity Index). Ultrasonography of the clinically involved digits was performed for evidence of distal interphalangeal joint enthesitis. Results: Out of 20 patients, 18 patients had cutaneous psoriasis and 2 had isolated nail involvement. Among the 18 patients with skin psoriasis, 4 had associated psoriatic arthritis. The most commonly observed clinical and onychoscopic features were pitting (31.2% and 42.2%), onycholysis (36% and 36.5%) and subungual hyperkeratosis (30.2% and 30.5%), respectively. Ultrasonographic evidence of distal interphalangeal joint enthesitis was seen in 57% (175/307) of the digits with clinical nail involvement. Enthesitis was more common in patients with psoriatic arthritis (77% vs 50.6%). Nail thickening, crumbling and onychorrhexis (all features of nail matrix involvement) were significantly associated with enthesitis (P < 0.005). Limitations: The major limitation was the small sample size and lack of controls. Only the clinically involved digits were evaluated for enthesitis. Conclusions: Enthesitis was frequently detected on ultrasonography in patients with nail psoriasis, even in clinically asymptomatic individuals. Nail features of thickening, crumbling and onychorrhexis may predict underlying enthesitis and the potential development of arthritis. A comprehensive evaluation could help identify patients with psoriasis at risk for arthritis, helping improve long-term outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate guselkumab efficacy on regional psoriasis in a subset of psoriasis patients with a self-reported psoriatic arthritis (PsA) diagnosis. Methods: In the phase 3 VOYAGE-1 and -2 studies, at week (W)0, patients with moderate-to-severe psoriasis were randomized to guselkumab 100 mg, placebo → guselkumab 100 mg at W16 through W44, or adalimumab 80 mg then 40 mg at W1 through W48 (VOYAGE-1) or W24 (VOYAGE-2). Pooled efficacy outcomes, including scalp-specific Investigator's Global Assessment (ss-IGA), hands and/or feet Physician's Global Assessment (hf-PGA), fingernail PGA (f-PGA), Nail Psoriasis Area and Severity Index (NAPSI), and Dermatology Life Quality Index (DLQI), were compared (nominal p-values) through W24 in patients with self-reported PsA diagnosis. Response rates/percentage improvement from baseline were determined, employing treatment failure rules and non-response/no improvement data imputation. Results: A total of 76, 153, and 106 psoriasis patients with self-reported PsA were randomized to the placebo, guselkumab, or adalimumab groups, respectively; the baseline characteristics of patients in all three arms were comparable. At W16, a greater proportion of guselkumab- versus placebo-treated patients achieved ss-IGA 0/1 (80.6% vs. 22.7%, p < 0.001), hf-PGA 0/1 (68.9% vs. 14.8%, p < 0.001), f-PGA 0/1 (47.6% vs. 17.0%, p < 0.001), and DLQI 0/1 (45.6% vs. 2.7%, p < 0.001) responses; mean percentage NAPSI improvement was also greater with guselkumab (39.5% vs. 6.5%, p < 0.001). At W24, patients receiving guselkumab had higher ss-IGA 0/1 (77.5% vs. 58.5%, p = 0.003) and DLQI 0/1 (47.7% vs. 34.3%, p = 0.024) response rates versus those receiving adalimumab. Response rates/mean percentage improvements at W48 (VOYAGE-1) were numerically greater with guselkumab than adalimumab (e.g., NAPSI improvement: 75.6% vs. 60.9%). Conclusions: Guselkumab-treated patients with psoriasis and self-reported PsA showed meaningful improvements in nail, scalp, and palmoplantar psoriasis. Trial Registration: VOYAGE-1 (ClinicalTrials.gov Identifier: NCT02207231) and VOYAGE-2 (ClinicalTrials.gov Identifier: NCT02207244). [ABSTRACT FROM AUTHOR]

Nail psoriasis is a difficult-to-treat manifestation of psoriatic disease affecting up to 80% of patients with psoriatic arthritis (PsA) and 40–60% of patients with plaque psoriasis (PsO). Ixekizumab (IXE), a high-affinity monoclonal antibody that selectively targets interleukin-17A, is approved for the treatment of patients with PsA and patients with moderate-to-severe PsO. This narrative review aims to summarize nail psoriasis data generated from IXE clinical trials in patients with PsA (SPIRIT-P1, SPIRIT-P2, and SPIRIT-H2H) and/or moderate-to-severe PsO (UNCOVER-1, -2, -3, IXORA-R, IXORA-S, and IXORA-PEDS) with an emphasis on head-to-head clinical trial data. Across numerous trials explored, IXE treatment was associated with greater improvement in resolution of nail disease versus comparators at week 24, results which were maintained up to and beyond week 52. Additionally, patients experienced higher rates of resolution of nail disease versus comparators at week 24 and maintained high levels of resolution up to week 52 and beyond. In both PsA and PsO, IXE demonstrated efficacy in treating nail psoriasis, and therefore may be an effective therapy option. Trial Registration: ClinicalTrials.gov identifier UNCOVER-1 (NCT01474512), UNCOVER-2 (NCT01597245), UNCOVER-3 (NCT01646177), IXORA-PEDS (NCT03073200), IXORA-S (NCT02561806), IXORA-R (NCT03573323), SPIRIT-P1 (NCT01695239), SPIRIT-P2 (NCT02349295), SPIRIT-H2H (NCT03151551). [ABSTRACT FROM AUTHOR]

Background: Psoriasis is a common, chronic, inflammatory skin disorder affecting almost 2-3% of the population. Studies on the epidemiological data and the course of the disease have generally been published in pediatric and middle-aged patients, where the disease is more common. This study aimed to provide more insight into the disease and treatment characteristics of psoriasis patients over 65. Materials and Methods: In this retrospective, cross-sectional, single-center, hospital-based study, patients over 65 who visited our department between 01.06.2017 and 01.06.2020 were included. Results: Ninety six patients with psoriasis were admitted to our outpatient clinic during the study period. The mean age of the patients was 69.92±4.73 years. Women and men were equally affected. Almost 9.4% of the patients had psoriatic arthritis. The patients’ mean Psoriasis Area Severity Index score was 8.39±7.11, and the disease duration was 13.76±12.71 years. Nail involvement was detected in 43.8% of the patients. Family history was positive in 19.8% of the patients. Smoking was positive in 28.1% of the patients, and regular alcohol use was positive in 6.3%. Conclusion: The clinical course of psoriasis is usually milder in elderly onset patients. Further studies are warranted to determine the best management of psoriasis in elderly patients. Drug interactions and metabolism should be carefully managed in these patients. [ABSTRACT FROM AUTHOR]

Nail psoriasis is an inflammatory disorder without a potential scarring outcome, but the nail signs, even the milder ones, can cause discomfort to patients and severely affect their quality of life. Nail psoriasis may be associated with psoriatic arthritis and when it starts during infancy, it may be a predictor of a more severe disease course in adulthood. All these issues contribute to the high economic burden of psoriasis. Nail psoriasis is notoriously difficult to treat, even though new treatments are in continuous development. This paper provides an update on new treatments and address the current gaps in care of nail psoriasis. A better understanding of the disease pathogenesis and more 'real-life' studies will definitely be helpful to improve treatment results. A lower level of heterogeneity should be advisable among trials when evaluating nail psoriasis. Moreover, the relationship between nail psoriasis and psoriatic arthritis should be the focus of unbiased studies in order to better define the real risk that nail psoriasis patients have to develop arthritis. [ABSTRACT FROM AUTHOR]

Nail psoriasis has a prevalence that ranges from 10 to 82% and can significantly impact the quality of life of patients. Nail psoriasis is one of the most challenging areas to treat, and multiple therapies have been explored. Topical and injectable therapies are recommended for few-nail disease. Systemic therapies, including biologics, can be considered for patients with multiple and resistant nail disease, impaired quality of life, and severe skin and joint involvement, due to their long-term efficacy. Although outcome data are difficult to compare, interleukin (IL)-17 inhibitors may have superior short-term efficacy when compared to IL-23 inhibitors and tumor necrosis factor (TNF)-alpha inhibitors, although long-term efficacy is similar to TNF-alpha inhibitors. IL-23 inhibitors and TNF-alpha inhibitors have a similar efficacy for nail psoriasis.

Objective To assess the clinical efficacy and safety of cyclosporin, adalimumab and secukinumab in the treatment of nail psoriasis. Methods Ninety-one patients with nail psoriasis from our hospital were randomly divided into cyclosporin group (30 cases), adalimumab group (31 cases) and secukinumab group (30 cases). The nail psoriasis severity index (NAPSI) and dermatology life quality index (DLQI) in the three groups were compared before and after 12-and 24-week treatments. Clinical effectiveness and adverse reactions were observed. Results Before the treatment, there were no significant differences in NAPSI and DLQI scores among the three groups (P>0.05). After 12 weeks of the treatment, the NAPSIs in the adalimumab and the secukinumab groups were lower than that in cyclosporin group (32.16±13.82, 32.37±10.97 vs 42.20±16.66, P0.05). There were no significant differences in adverse reactions among the three groups (P=0.784). Conclusions Cyclosporin, secukinumab and adalimumab are effective and safe for nail psoriasis. Both secukinumab and adalimumab are more effective than cyclosporin, while the efficacies of secukinumab and adalimumab are comparable.

Key Clinical Message This clinical case demonstrates quick resolution of nail psoriasis in a patient treated with risankizumab, highlighting the role of IL‐23 in the pathogenesis of nail psoriasis.

Background: Up to 30-50% of cases of psoriasis experience nail involvement, while 5-10% may have only isolated nail disease. Recently, the use of onychoscopy, a non-invasive technology, has emerged as a promising tool that may eliminate the necessity of a nail biopsy in most cases. Objective: The objective of this study was to assess the onychoscopic characteristics of the nail unit in individuals with nail psoriasis. Materials and Methods: The study recruited fifty patients with a clinical diagnosis of nail psoriasis. Each nail underwent onychoscopic assessment. The clinical degree of cutaneous and nail involvement was evaluated with the Psoriasis Area and Severity Index (PASI) and the Nail Psoriasis Severity Index (NAPSI), respectively. Results: The following findings were observed significantly more often on onychoscopy than with the naked eye: pitting (p = 0.03), leukonychia (p = 0.04), onycholysis (p = 0.04), and splinted hemorrhage (p = 0.05). The other novel findings included fuzzy lunula, which was only onychoscopically (8%), We also encountered 4% of cases of triangular onychomadesis and 6% of non-traumatic Median canaliform dystrophy of Heller. Conclusion: Our findings suggest that, even before clinical symptoms become obvious, onychoscopy may help with nail lesion diagnosis. [ABSTRACT FROM AUTHOR]

Background Psoriasis is a common immune mediated, multifactorial disease which is caused by genetic heterogeneity and phenotypic diversities.1 It is characterized by red, scaly, sharply demarcated, indurate plaques mostly over scalp and extensor surface affecting 2-3% global population.3,4 Beside cutaneous involvement, nail involvement is quite common in psoriasis patient (50%) and 5% cases had only nail involvement.5,6 Objective To assess the frequency, types of nail involvement in psoriasis patient and its association with the disease severity. Methods Institution based Cross-sectional study on 100 consecutive patients attending Outpatient department was done for a period of 1 year March 2019 to February 2020. Results 48% have nail changes with male having twice that of female. The mean age of the patients having nail changes was 42.450 with SD 13. Isolated finger nail and Toe nail involvement was noted in 52% and 1%, while 46% have both. Majority nail changes were pitting (68%), distal onycholysis (38%), longitudinal ridging (25%), subungual hyperkeratosis 22%, proximal onycholysis 19%, transverse ridging 8% etc.77% patient with nail changes has disease duration less than 5 years. Frequency of nail changes was noted highest in patient with severe disease (64.58%). Conclusion Psoriatic nail changes are common in psoriasis patients. Severe nail psoriasis can lead to functional and social impairment if left untreated. An association was noted between severity of psoriasis and nail changes but elaborate study with large samples are required to establish that relationship. [ABSTRACT FROM AUTHOR]

Phototherapy has been one of the first and still frequently used treatment modality for psoriasis. In the last decades, different types of lasers have been used for the treatment of psoriasis and other inflammatory skin diseases with variable success. Efficacy and safety of laser devices and intense pulsed light for the treatment of psoriasis. The literature search was conducted using the bibliographic databases MEDLINE, EMBASE, and Cochrane. Search terms included 'laser' AND 'psoriasis,' 'IPL' AND 'psoriasis,' 'intense pulsed light' AND 'psoriasis.' Due to its high efficacy and safety profile, 308-nm Excimer laser retains its specific place in the treatment of plaque psoriasis as a first- or second-line therapy in mild disease or as an adjuvant treatment in case of partial response to systemic treatments in moderate-to-severe disease. Vascular lasers remain a last line therapy that can be tried in patients with recalcitrant limited plaques or nail affection. They are easy to apply and have a very good safety profile and tolerability, but the efficacy is limited. Fractional ablative lasers for application of laser-assisted drug delivery appear interesting and a topic for further research. When using lasers for psoriasis, a good pre-treatment is mandatory. [ABSTRACT FROM AUTHOR]

Purpose of Review: To study the prevalence of onychomycosis in patients with psoriasis. Fifty patients older than 18 years diagnosed with psoriasis were included. Direct examination with KOH and mycological culture were performed to diagnose onychomycosis. Recent Findings: Nails with alterations caused by psoriasis may be vulnerable to onychomycosis since clinical abnormalities such as onycholysis and hyperkeratosis are factors that disrupt this barrier and predispose to nail invasion. It has been reported that the prevalence of onychomycosis in patients with psoriasis varies from 4.6 to 63.1%. Summary: We found nail changes in 90% of patients; subungual hyperkeratosis alteration was predominant. Prevalence of onychomycosis was 38%, predominating the total dystrophic presentation and male gender, age from 51 to 60 and 61 to 70 years; significant association with nail alteration was found (p = 0.0200). Trichophyton rubrum and Trichosporon sp. were the most isolated fungi. It is important to study this correlation, since onychomycosis can be a source of dissemination to the skin or other areas, as well as generate cosmetic problems and functional impairment. [ABSTRACT FROM AUTHOR]

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Nail psoriasis is a clinical manifestation of psoriasis involving the nails, with prevalence of 80%~90%. Changes in nail appearance and pain can negatively impact the quality of patients′ lives. The treatment regimens for nail psoriasis include local treatment, systemic treatment and physical therapy. Traditional therapy requires long-term treatment with uncertain outcomes. In recent years, the efficacy and the course of treatment have been improved by new regimens such as biologics and small molecule drugs. This article will review the treatment of nail psoriasis in order to facilitate the selection of most appropriate approach for the treatment of nail psoriasis.

Background: Nail involvement is a feature of 30%–50% of psoriasis patients. Only 5%–10% of patients have isolated nail psoriasis. Examination of the nail unit using a dermoscope is known as onychoscopy. The usefulness of onychoscopy in the early detection of nail psoriasis needs to be evaluated. Objective: The objective of this study was to describe the onychoscopic features in chronic plaque psoriasis patients. Materials and Methods: In this cross-sectional study, 100 patients with chronic plaque psoriasis were recruited. Onychoscopy was performed, and results were compared with the same age- and sex-matched controls. The various onychoscopic features were assessed using the Chi-square test (P < 0.05 was considered significant). The statistical analysis was done using the application named Epi Info™. Results: Out of 100 psoriasis patients, 39 patients showed clinically evident nail involvement on the naked eye, whereas 64 patients showed nail involvement on onychoscopic examination. The mean age of patients observed in our study was 37.5 years. Out of 64 patients, 43 were male and 21 were female. Pitting was the most common finding seen in 55 (85.93% and P = 0.0001) patients, followed by transverse groove in 18 (28.12% and P = 0.025), subungual hyperkeratosis in 16 (25% and P = 0.035), nail plate crumbling in 16 (25% and P = 0.0009), and oil drop sign in 8 (12.5% and P = 0.010) patients. Only these five parameters were statistically significant. Furthermore, other findings observed were onycholysis in 7 (10.93% and P = 0.166), leukonychia in 12 (18.75% and P = 0.614), splinter hemorrhages in 8 (12.5% and P = 0.099), pseudo-fiber sign in 4 (6.25% and P = 0.127), lunular red spots in 3 (4.68% and P = 0.242), and dilated globose vessels were seen in 4 (6.25% and P = 0.127) patients. Conclusion: Onychoscopy is a useful noninvasive method to detect subclinical nail involvement, which may not be visible to the naked eye.

Background: Nail disorders account for about 10% of all dermatological conditions. Onychoscopy is useful not only for their diagnosis but also for assessing severity/progression and monitoring the response to therapy. Aims and Objectives: Describing dermoscopic features of nail disorders in patients reporting to the dermatology OPD of our tertiary care hospital and recording the sociodemographic profiles thereof. Materials and Methods: This cross-sectional observational study was carried out on 176 patients with effect from August 2019 to August 2021. Results: Males (99; 56.25%) outnumbered females (77; 43.75%); males: female: 1.28: 1; their mean age was 35.8 years. Fingernails were affected more oftener (84.09%) than toenails (38.64%). Onychomycosis, the commonest (58;32.95%) condition, revealed findings of aurora borealis pattern (75.86%), subungual hyperkeratosis (72.41%), and onycholysis with jagged edges and spikes (68.97%). The next frequent (32;18.18%) condition was nail psoriasis which revealed pits (81.25%); onycholysis (62.5%) and dilated globose nail fold vessels on capillaroscopy (25%). Limitations: The small sample size proved inadequate for the evaluation of statistical significance in the less common conditions and the correlation of disease severity of many. Ideally, confirmatory diagnostic tests should have been done in every patient, as indicated. The magnification of our dermoscopy was 10X; 20- and 40X permit better capillaroscopy. Conclusions: Onychocopy can minimize the need for biopsy by highlighting subtle changes and helps narrow down the differentials. It is potentially a diagnostic test of choice in younger children. Our study helped to grade the severity of connective tissue disorders and establish the benignity of melanonychia. Photographic documentation facilitates record-keeping.

Nail conditions are not only aesthetic concerns, and nail changes may be a clue to an underlying systemic diseases or infection. Without timely treatment, nail diseases can continue to worsen and significantly impair performance of daily activities and reduce quality of life. Examination of the nails is essential at every medical visit, and may uncover important findings. Brittle nail syndrome, onychomycosis, paronychia, nail psoriasis, longitudinal melanonychia, Beau’s lines, onychomadesis and retronychia are common nail disorders seen in clinical practice. These conditions stem from infectious, inflammatory, neoplastic and traumatic aetiologies. Though each nail condition presents with its own distinct characteristics, the clinical findings may overlap between different conditions, resulting in misdiagnosis and treatment delays. Patients can present with nail plate changes (e.g. hyperkeratosis, onycholysis, pitting), discolouration, pain and inflammation. The diagnostic work-up of nail disease should include a detailed history and clinical examination of all 20 nail units. Dermoscopy, diagnostic imaging and histopathologic and mycological analyses may be necessary for diagnosis. Nail findings concerning for malignancy should be promptly referred to a dermatologist for evaluation and biopsy. Nail disease management requires a targeted treatment approach. Treatments include topical and/or systemic medications, discontinuation of offending drugs or surgical intervention, depending on the condition. Patient education on proper nail care and techniques to minimize further damage to the affected nails is also important. This article serves to enhance familiarity of the most common nail disorders seen in clinical practice. It will highlight the key clinical manifestations, systematic approaches to diagnosis and treatment options for each nail condition to improve diagnosis and management of nail diseases, as well as patient outcomes.Key messagesNail disease is not only a cosmetic issue, as nail changes can indicate the presence of a serious underlying systemic disease, infection or malignancy.Nail pain and changes associated with NP are physically and emotionally distressing and may contribute to functional impairment and diminished quality of life.LM is a hallmark sign of subungual melanoma and this finding warrants further investigation to rule out malignancy.

Abstract Background This study aimed to report a case of bilateral anterior non-granulomatous chronic non-infectious uveitis associated with isolated nail psoriasis without articular involvement. Case presentation A 55-year-old man with a history of open-angle glaucoma was referred to our uveitis and ocular immunology center with intraocular inflammation concordant with chronic non-infectious bilateral anterior non-granulomatous uveitis. At presentation, he had moderate inflammation in the anterior chamber bilaterally and lesions characteristic of nail psoriasis. Nail psoriasis was later confirmed by nail ultrasonography performed by a radiologist who specialized in psoriasis. Appropriate clinical and paraclinical assessments were conducted, ruling out all other possible causes of uveitis. The patient required dual systemic immunomodulatory therapy with methotrexate and adalimumab, topical anti-inflammatory drugs (steroidal and non-steroidal), and anti-glaucoma therapy to achieve satisfactory inflammatory and ocular pressure control. Discussion and conclusions This is the first report of non-infectious uveitis associated with nail compromise in a patient without other manifestations of psoriasis. Despite reports on the relationship between psoriatic disease and uveitis, there is insufficient information on clinical phenotypes associated with uveitis that could lead to later diagnosis and treatment of associated intraocular inflammation. Clinicians should be aware of all subtypes of psoriasis that increases a risk of developing uveitis in these patients.

摘要 目的 观察环孢素、阿达木单抗、司库奇尤单抗治疗甲银屑病的临床疗效及安全性。方法 选择我院门诊就诊的甲银屑病患者共计91例,随机分为环孢素组(30例)、阿达木单抗组(31例)、司库奇尤单抗组(30例),比较三组患者在治疗前、治疗12周、治疗24周后的甲银屑病程度指数(NAPSI)、皮肤病生活质量评分(DLQI),观察临床有效率以及不良反应发生率。结果 三组患者治疗前NAPSI评分、DLQI评分对比无显著差异(P>0.05)。治疗12周后,阿达木单抗组及司库奇尤单抗组NAPSI评分低于环孢素组(32.16±13.82、32.37±10.97 比 42.20±16.66,P<0.05),NAPSI评分平均改善率高于环孢素组[(37.34±13.00)%、(35.42±9.61)% 比 (20.38±8.15)%,P<0.05)]。治疗24周后,阿达木单抗组及司库奇尤单抗组NAPSI评分明显低于环孢素组(17.81±14.72、19.27±9.90 比 31.17±15.14,P<0.05),NAPSI评分平均改善率高于环孢素组[(66.86±22.97)%、(61.86±15.68)% 比 (42.84±15.29)%,P<0.05)],DLQI评分低于环孢素组(4.71±4.52、6.30±5.04 比 10.43±8.50,P<0.05),治疗后DLQI评分差值大于环孢素组(-6.23±5.70、-5.90±3.83比-3.20±4.92,P<0.05),临床有效率高于环孢素组(64.52%、60.00% 比 23.33%,P<0.05)。阿达木单抗组与司库奇尤单抗组在治疗12、24周后的NAPSI评分及其改善率,治疗24周后的DLQI评分及其差值,以及临床有效率比较,均无统计学差异(均P>0.05)。三组间不良反应发生率无统计学差异(P=0.784)。结论 环孢素、阿达木单抗、司库奇尤单抗均可改善甲银屑病患者的生活质量,对甲银屑病有一定疗效,安全性均在耐受范围。阿达木单抗、司库奇尤单抗较环孢素疗效更佳,而阿达木单抗与司库奇尤单抗之间无明显差异。 Abstract Objective To assess the clinical efficacy and safety of cyclosporin, adalimumab and secukinumab in the treatment of nail psoriasis. Methods Ninety-one patients with nail psoriasis from our hospital were randomly divided into cyclosporin group (30 cases), adalimumab group (31 cases) and secukinumab group (30 cases). The nail psoriasis severity index (NAPSI) and dermatology life quality index (DLQI) in the three groups were compared before and after 12-and 24-week treatments. Clinical effectiveness and adverse reactions were observed. Results Before the treatment, there were no significant differences in NAPSI and DLQI scores among the three groups (P>0.05). After 12 weeks of the treatment, the NAPSIs in the adalimumab and the secukinumab groups were lower than that in cyclosporin group (32.16±13.82,32.37±10.97 vs 42.20±16.66, P<0.05); The average improvement rates of NAPSI in both the adalimumab and the secukinumab groups were higher than that in the cyclosporin group[(37.34±13.00)%,(35.42±9.61)% vs (20.38±8.15)%,P<0.05)]. After 24 weeks of the treatment, the NAPSIs in the adalimumab and the secukinumab groups were significantly lower than that in the cyclosporin group (17.81±14.72,19.27±9.90 vs 31.17±15.14, P<0.05); The average improvement rates of NAPSI in the adalimumab and the secukinumab groups were higher than that in the cyclosporin group [(66.86±22.97)%,(61.86±15.68)% vs (42.84±15.29)%,P<0.05)]. DLQI in both the adalimumab and the secukinumab groups were lower than that in the cyclosporin group (4.71±4.52, 6.30±5.04 vs 10.43±8.50, P<0.05). The changes in DLQIs were more dramatic in the adalimumab and the secukinumab groups than in the cyclosporin group (-6.23±5.70 and -5.90±3.83 vs -3.20±4.92, P<0.05). The effective rates in both the adalimumab and secukinumab groups were higher than that in the cyclosporin group (64.52% and 60.00% vs 23.33%, P<0.05). However, neither NAPSIs nor improvement rates differed significantly between the adalimumab and secukinumab groups after 12-or 24-week treatments. Likewise, DLQIs were similar in the adalimumab and secukinumab groups after 24-week treatments (P>0.05). There were no significant differences in adverse reactions among the three groups (P=0.784). Conclusions Cyclosporin, secukinumab and adalimumab are effective and safe for nail psoriasis. Both secukinumab and adalimumab are more effective than cyclosporin, while the efficacies of secukinumab and adalimumab are comparable. [ABSTRACT FROM AUTHOR]

Background: In cases when only the nails are affected by psoriasis, treatment has proven extremely difficult. Psoriatic nail alterations may begin as a Koebner isomorphic reaction to mechanical damage, just as with cutaneous psoriasis. Clinicians should advise patients to take the required safety measures to reduce the risk of the Koebner phenomenon. Gloves and hand lotions can protect hands from harm and encourage short nails. Objective: Review of literature about assessment of management lines of nail psoriasis. Methods: We searched PubMed, Google Scholar, and Science Direct for relevant articles on nail psoriasis and management. However, only the most recent or thorough study was taken into account between January 2012 and March 2022. The authors also evaluated the value of resources culled from other works in the same genre. Therefore, documents written in languages other than English have been ignored due to a lack of translation funds. Unpublished works, oral presentations, conference abstracts, and dissertations were generally agreed upon not to qualify as scientific research. Conclusion: In cases when only the nails are affected by psoriasis, treatment has proven extremely difficult. The major causes of this problem are the sluggish growth rate of the nails and the low penetration of topical drugs. Treatment options such as etanercept, intralesional corticosteroids, ustekinumab, acitretin, methotrexate sodium, and adalimumab are suggested for patients with severe nail disease that has not responded to topical medication. Ustekinumab, adalimumab as well as etanercept, are highly advised for people with severe skin and nail disorders. Also, methotrexate, acitretin, infliximab, and apremilast are suggested. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to assess the discriminative utility of nail features detected by B-mode (BM), enhanced flow (eflow) and power Doppler (PD) in patients with psoriasis or nail psoriasis (NP) and healthy controls. PATIENTS AND METHODS: Ultrasound appearance of nails was investigated in 5 patients with NP, 8 patients with psoriasis and 7 healthy controls. In total, 195 nails were examined. RESULTS: The thickness of the nail bed (TNB), the thickness of the nail plate (TNP) and the thickness of the nail matrix (TNM) did not differentiate between NP and psoriasis in longitudinal and cross-section of nails. Resistance index (RI) in nails was higher in patients with NP than in patients with psoriasis, and significantly higher in patients with psoriasis than in healthy controls. TNP between patients with psoriasis and healthy controls was statistically insignificant in longitudinal section of nails, but higher than that in the cross-section of nails. TNM was higher in patients with psoriasis than in healthy controls. The ultrasound features of NP in longitudinal and cross-section of nails, nail bed (NB) eflow and PD signal were statistically significant among patients with NP or psoriasis and healthy controls. In patients with NP, there was a correlation between the ultrasound features of NP in longitudinal and cross-section of nails and nail psoriasis severity index (NAPSI). CONCLUSIONS: Our study displayed the usefulness of ultrasound nail examinations in psoriatic nails, not only assessing ultrasonic features of nails and proving correlation between ultrasonic features of nails and NAPSI, but also comparing the accuracy of new technology of blood flow signal in nails. [ABSTRACT FROM AUTHOR]