Psoriatic nails
| Psoriatic nails | |
|---|---|
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Psoriasis of the toenails.
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| Classification and external resources | |
| Specialty | Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value). |
| ICD-10 | L62.8 |
| Patient UK | Psoriatic nails |
Psoriatic nails is a nail disease. It is common in those suffering from psoriasis, with reported incidences varying from 10% to 78%. Elderly patients and those with psoriatic arthritis are more likely to have psoriatic nails.[1]:781–2
Contents
Symptoms
- a translucent discolouration in the nail bed that resembles a drop of oil beneath the nail plate.[2]
Diagnosis
The Nail Psoriasis Severity Index (NAPSI) is a numeric, reproducible, objective, simple tool for evaluation of nail psoriasis.[3] It evaluates several signs separately, each on a 1–3 scale: pitting, Beau's lines, subungual hyperkeratosis and onycholysis. A 2005 study proposed a modified NAPSI scale for persons with psoriasis and named the title of their publication "Modification of the Nail Psoriasis Severity Index".[4] Then, in 2007, a study found that there was a high level of inter-rater variability of the 2003 NAPSI scale and proposed another index which was, like the 2005 article, a modification of the 2003 article, and was named modified NAPSI.[5] A 2008 study found that Cannavo's qualitative system[6] correlated with NAPSI (P<0.001) and is less time-consuming.[7]
There is a risk of misdiagnosis with onychomycosis.
Causes
The causes of nail psoriasis are unknown. It has been suggested that fungi may play a role.[8]
Treatment
There exist numerous treatments for nail psoriasis but there is little information concerning their effectiveness and safety.[9] Treatments include topical, intralesional, radiation, systemic, and combination therapies.
- Tacalcitol ointment[10] obtains a significant improvement in all nail parameters, both of the matrix and of the bed.
- Clobetasol nail lacquer and tacalcitol ointment[11]
- 5-fluorouracil. A reported side-effect is yellow nails[12]
- Calcipotriol[13]
- Calcipotriol plus betamethasone dipropionate ointment.[14]
- Efalizumab [15]
- Infliximab[16]
- Golimumab[17]
- Low dose methotrexate[18]
- Intralesional corticosteroid injection[19]
Relative effectiveness of treatments
Available studies lack sufficient power to extrapolate a standardized therapeutic regimen.[9] As of April 2009, an assessment of the evidence for the efficacy and safety of the treatments for nail psoriasis is in progress.[20]
- Infliximab appears to be the most effective treatment for nail psoriasis to date.[21]
- Results from low-dose acitretin therapy show NAPSI score reductions comparable with those studies evaluating biologic drugs for nail psoriasis and suggest that low-dose systemic acitretin should be considered in the treatment of nail psoriasis.[21]
Research
Active clinical trials investigating nail psoriasis:[22]
Phase IV
- Effects of Etanercept.[23]
- Effects of Golimumab.[17]
Phase II
- Dose response and safety of topical Methotrexate.[24]
See also
References
- ↑ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
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- ↑ 17.0 17.1 Clinical trial number NCT00265096 at ClinicalTrials.gov
- ↑ http://dermatology-s10.cdlib.org/1511/case_presentations/mtx_nail/lee.html
- ↑ Lua error in package.lua at line 80: module 'strict' not found.
- ↑ doi:10.1002/14651858.CD007633
- ↑ 21.0 21.1 Lua error in package.lua at line 80: module 'strict' not found.
- ↑ clinicaltrials.gov
- ↑ Clinical trial number NCT00581100 at ClinicalTrials.gov
- ↑ Clinical trial number NCT00666354 at ClinicalTrials.gov
