Nail Psoriasis: An Updated Review and Expert Opinion on Available Treatments, Including Biologics
Federico Bardazzi, Michela Starace, Francesca Bruni, Michela Magnano, Bianca Maria Piraccini, Aurora Alessandrini
Nail psoriasis affects 50–79% of patients with skin psoriasis and up to 80% of patients with psoriatic arthritis, and can also represent a negative prognostic factor in individuals with plaque psoriasis. Treatments for nail psoriasis are limited, as nails are often difficult to treat with topical therapies alone, and relapse is common. Among different systemic agents, secukinumab, a fully human monoclonal antibody targeting interleukin (IL)-17A, is the only antibody supported by a trial specifically conducted in patients with nail psoriasis (the TRANSFIGURE trial) and has the longest follow-up available to date. In this setting, secukinumab is characterized by the highest efficacy at week 16. This review analysed the different therapeutic options for nail psoriasis, focusing on new treatments that have shown promising results in this field.
Nail psoriasis frequently affects patients with skin psoriasis, inducing not only aesthetic problems, but also functional damage. The disease represents a significant burden, impairing patients’ quality of life. The treatment of nail psoriasis varies according to disease severity. Topical therapies are used if the nail involvement is mild, but their efficacy is limited and relapses are common. In more serious cases, systemic agents (both traditional and biologic molecules) have shown long-term efficacy. Among biologics, secukinumab is the only agent supported by evidence from a trial specifically conducted in patients with nail psoriasis.