When Nail Polish Doesn't Work

Nail psoriasis treated like regular skin psoriasis

(RxWiki News) A regular manicure and pedicure probably won't be enough to relieve the pain and yellowing nails found in people with nail psoriasis. Regular psoriasis treatments may be the way to go.

Typical treatments for skin psoriasis also relieved symptoms and improved quality of life in patients who had the disorder only in their nails, according to a recently published study.

Researchers said that their findings could help guide clinicians in their practice and provide patients with a variety of treatment options.

"Family history of psoriasis? Tell a doctor."

Nails affected by psoriasis can be pitted and yellowed with white areas under the nail plate. Less than 5 percent of psoriasis patients have the condition only in their nails, which is often difficult to diagnose alone.

The study, led by Anna de Vries, PhD, from the Department of Dermatology at the Academic Medical Center in the Netherlands, looked at how well treatments relieved nail dryness, scales and other symptoms. Like skin psoriasis, nail psoriasis has no cure.

Researchers also examined how safe the treatments were, how patients' quality of life was affected and whether the treatments caused any side effects.

Researchers reviewed 18 previous psoriasis studies that included more than 1,200 participants. More than half the studies covered topical treatments, or treatments placed on the skin.

Another five studies looked at systemic treatments, or medications in a pill form. Three studies investigated radiation therapy.

Radiation therapy includes superficial radiation therapy, electron beam and grenz ray treatments, which are low energy x-rays that penetrate the top layer of skin.

Doctors and patients tracked different features of the nails during treatment, including their thickness, growth rate and the number of nails affected by psoriasis. Treatments lasted two weeks to as long as 64 weeks from study to study.

Researchers tracked the changes more than a year after beginning treatment. They found that nail psoriasis symptoms improved with topical and systemic treatments in five of the studies.

Treatments containing infliximab (marketed as Remicade) significantly improved nails by more than 57 percent compared to a fake treatment.

Another systemic treatment containing golimumab (sold as Simponi) also improved nails by 33 percent. Higher doses improved nails by as much as 54 percent.

Psoriasis symptoms in the nails also improved with radiation therapy though the treatments were not often used. 

Because systemic treatments can cause potentially dangerous side effects, the researchers said it was impractical for patients who only had nail psoriasis to use these treatments first.

"[Systemic treatments] are not a realistic option for people troubled with nail psoriasis, unless the patient is prescribed these systemic treatments because of cutaneous psoriasis or psoriatic arthritis or the nail psoriasis is severe, refractory to other treatments, or has a major impact on the person's quality of life," the researchers wrote in their report.

The researchers noted that the findings from some of their included studies may be biased since researchers knew who was receiving which treatment and some of the data was incomplete or selectively reported.

The study, funded by the Department of Dermatology of the University of Amsterdam, Dutch Cochrane Centre and Mount Sinai School of Medicine, was published January 31 in The Cochrane Library.

One of the authors was an advisor for a number of pharmaceutical companies and received honoraria and grants for his work that may have been of interest to the study.

Review Date: 
March 6, 2013