Nail psoriasis

Nail psoriasis is observed in approximately 50% of patients with common psoriasis and over 80% of patients with psoriatic arthritis. Its clinical presentation may vary, but the most frequent and/or troublesome symptoms are pitting, subungual hyperkeratosis and onycholysis. Nail psoriasis has a very negative impact on quality of life. There are also data indicating a link between nail changes and psoriatic arthritis, particularly distal interphalangeal joint involvement. Persistent, severe nail changes seem to be one of the major predictors of psoriatic arthritis development. For evaluation of nail psoriasis severity the NASI scale was introduced. There are no recommended methods of treatment. Some improvement may be observed during therapy with all systemic drugs, mainly retinoids. Among new preparations controlled clinical trials confirm the efficacy of infliximab, and clinical observations of adalimumab. Nevertheless, the most frequently used are topical therapies. The most effective are topical corticosteroids, especially in periungual injections. However, this therapy may produce some severe side effects. Safer seems to be treatment with vitamin D and vitamin A derivatives calcipotriol and tazarotene, but their efficacy depends on method of application – with or without occlusion or combination with topical corticosteroids. Therefore managing patients with nail psoriasis remains a big problem