Recommendations for the definition, evaluation, and treatment of nail psoriasis in adult patients with no or mild skin psoriasis: a dermatologist and nail expert group consensus

Publication date: Available online 5 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Dimitrios Rigopoulos, Robert Baran, Soumiya Chiheb, Carlton Ralph Daniel, Nilton Di Chiacchio, Stamatis Gregoriou, Chander Grover, Eckart Haneke, Matilde Iorizzo, Marcel Pasch, Bianca Maria Piraccini, Phoebe Rich, Bertrand Richert, Natalia Rompoti, Adam I. Rubin, Archana Singal, Michela Starace, Antonella Tosti, Ioanna Triantafyllopoulou, Martin Zaiac

Abstract

Nail involvement in psoriasis is common, and the severity of it does not always parallel the intensity of cutaneous disease.

We created a consensus group, of which the aim was to provide practical recommendations for the treatment of nail psoriasis in patients without skin psoriasis, or with mild skin lesions with no indication for a systemic treatment. This collaborative process was conducted by an international panel of dermatologists with special expertise in nail disorders, using a formal consensus methodology.

During this process, the panel strived to establish an agreement regarding the definition of nail psoriasis, the severity of nail psoriasis, and treatment response. Treatment recommendations are provided regarding nail psoriasis severity and matrix or bed involvement. "Few-nail" disease was considered as nail psoriasis affecting 3 or less nails. In the case of matrix involvement only, intralesional steroid injections were considered the treatment of choice. Topical steroids alone or in combination with topical vitamin D analogues were suggested for nail psoriasis limited to the nail bed. For the systemic treatment of nail psoriasis acitretin, methotrexate, cyclosporine, small molecules, and biologics can be employed.

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