What Else Can I Try
Non-drug treatments are the least researched of all treatments and have shown the least amount of promise for nail psoriasis. Because of this, they are not recommended as a first-line treatment for nail psoriasis. In most cases, they are only recommended when other treatment options have failed.1
Treatments in this category include laser treatment, phototherapy, and radiotherapy.
Much more research is on the treatment of PsA, plaque psoriasis, and nail psoriasis. Before beginning treatment for nail psoriasis, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.
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Psoriasis is a debilitating disease affecting over 8 million Americans. Besides the uncomfortable itchy, flaky, and scaly plaques that are common with the disease, most people with psoriasis are burdened with emotional and social side effects.
- About 24 percent have anxiety and about 10 percent have clinical depression.
- They feel embarrassed and unattractive.
- Theyre constantly worried the condition will get worse.
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Its Not Your Typical
Treatment Of Nail Psoriasis: Common Concepts And New Trends
Yasemin Oram
1Department of Dermatology, V.K. Foundation American Hospital of Istanbul, Turkey
Abstract
The lifetime incidence of nail involvement in psoriatic patients is estimated to be 8090%, and the nails can be affected in 10% to 55% of psoriatic patients. Psoriasis may also solely involve the nails, without any other skin findings, in which the treatment can be more challenging. Nail psoriasis may lead to considerable impairment in quality of life due to aesthetic concerns and more importantly limitations in daily activities resulting from the associated pain, which may be overlooked by the physicians. Several topical and systemic treatment modalities, as well as radiation and light systems, have been used in the treatment of nail psoriasis. In the last decade, the introduction of biologic agents and the utilization of laser systems have brought a new insight into the treatment of nail psoriasis. This paper focuses on the recent advances, as well as the conventional methods, in treating nail psoriasis in adults and children, in reference to an extensive literature search.
1. Introduction
2. General Nail Care
3. Topical Therapy
There is limited evidence for the efficacy of topical therapies in nail psoriasis. Various topical treatment modalities have been used in nail psoriasis including corticosteroids, dithranol, fluorouracil, vitamin D3 analogues, tacrolimus, cyclosporine, and tazarotene .
4. Intralesional Therapy
6. Systemic Therapy
7. Biologic Treatments
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Keeping Nails In Good Shape
In addition to following your doctor’s recommendations for treatment of nail psoriasis, there are other ways to take care of your nails:
- Keep your nails trimmed as short as possible.
- Wear gloves when you’re working with your hands.
- Wear shoes with plenty of room in them.
- Avoid scrubbing or scraping underneath your nails.
- Use gentle nail-cleaning tools.
- Soak your nails in tar bath oil mixed with water, then apply nail moisturizer.
- If your nails are intact, consider using a nail hardener to improve their appearance.
Laser Treatment For Nail Psoriasis
The results of a 2016 review suggest that receiving excimer laser treatment twice per week for 12 weeks could improve symptoms in nail, scalp, and palmoplantar psoriasis. In the following sections, we.
A few medicines such as beta-blockers, antimalarial drugs and lithium can also aggravate psoriasis, explains Dr Padmavathi Surapaneni, senior dermatologist and cosmetologist at Pragna Skin Laser.
Psoriasis can affect the fingernails & toenails & cause nail symptoms such as pitting, nail discoloration & splintering. A look at nail psoriasis treatment.
2. To assess the adverse events associated with excimer laser treatment of nail psoriasis. a. To compare immediate and delayed symptoms in excimer treated fingers compared to sham treated fingers. ·.
hierarchy of nail psoriasis therapy be-.
of treatment of nail psoriasis parallels.
Light energy based devices: excimer laser, PDL, Grenz Ray. 5.
In a recent study, ixekizumab was found to be efficacious at both treating and resolving nail psoriasis. 2 1. Maranda EL, Nguyen AH, Lim VM, Hafeez F, Jimenez JJ. Laser and light therapies for the.
It could be other problems, including nail cancer, nail psoriasis, or even a bony tumor under the.
Except theres not a lot of evidence that it does, says Dr. Lipner. Laser treatments havent been.
Topical treatments are generally recommended for nail psoriasis that is.
Treatments in this category include laser treatment, phototherapy,
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Can I Use Biologic Treatments
Biologic treatments are very similar to systemic treatments, both in usage and side effects. However, biologic treatments are newer. This means they are often more expensive and less researched.1
Many biologics target the body’s immune response. Drugs include:1
- Anti-tumor necrosis factor alpha blockers infliximab, adalimumab, etanercept, and golimumab
- Interleukin -17 inhibitors secukinumab, ixekizumab
- IL-12/23 inhibitors ustekinumab
Data Abstraction And Quality Assessment
Two independent reviewers abstracted data using a predefined data extraction form. The following information was extracted from each study: author, year of publication, design of study, blind time period, patient type, details of the interventions, sample size, baseline nail psoriasis involvement, and the improvement at each visit till the end of study. We independently assessed the quality of each included study in accordance with the Cochrane handbook of systematic reviews of interventions 5.2, which covers the following: random sequence generation allocation concealment blinding of participants and treatment providers blinding of outcome assessors , incomplete outcome data , selective reporting , and other biases. Disagreements over any risk of bias in particular studies were resolved by a third reviewer.
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Pathophysiology Of Nail Psoriasis
The pathogenesis of the psoriatic nail disorder is not completely known. Nail psoriasis may be due to a combination of genetic, environmental, and immune factors. A well-known fact is that a familial aggregation of psoriasis exists. Studies have linked psoriasis with certain human leukocyte antigen subtypes . A T-cellmediated inflammatory process is being investigated as part of the pathogenesis of psoriasis.
How Well Do Psoriasis Laser Treatments Work
Psoriasis laser treatments work well on people with mild-to-moderate psoriasis. But because the light is concentrated, it’s not effective for people with psoriasis on large areas of the body.
It may take several treatments before you see results.à After the treatment, your skin might stay clear for a while, even several months. But laser therapy canââ¬â¢t cure psoriasis. It treats plaques you already have. Over time, the spots are likely to come back. Youââ¬â¢ll need a new treatment cycle to target them again.
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Pulsed Dye Laser For The Treatment Of Nail Psoriasis
Cutis
-
- Steven R. Feldman, MD, PhD
Publish date: November 9, 2012
Dr. Feldman discusses UVB phototherapy for the treatment of psoriasis.
From the Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Florida.
The authors report no conflict of interest.
Correspondence: Sonal Choudhary, MD, 1475 NW 12th Ave, Ste 2175, Miami, FL 33136 .
Psoriasis can involve the skin, joints, and nails, either alone or in combination. Psoriasis of the nails can involve both the nail bed and nail matrix. The treatment of nail psoriasis largely depends on the severity of symptoms. The pulsed dye laser recently has demonstrated efficacy in treating resistant plaque-type psoriasis and has been suggested as an alternative to conventional therapies. We review 4 studies of PDL for nail psoriasis and discuss the findings in relation to treatment recommendations. Ultimately, a standardized regimen for the treatment of nail psoriasis remains elusive.
What You Should Know Before Starting Laser Treatment
Laser treatment for psoriasis can produce dramatic results in some people — but this therapy isn’t for everyone. To make sure you’re a good candidate, have a complete health history and exam done before starting treatment.
Avoid laser treatments if you have:
- Lupus or scleroderma
- Xeroderma pigmentosum
- Risks for, or a history of, skin cancer
- A condition that requires you to take medications that make you sensitive to the sunÃ
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Excimer For Nail Psoriasis
| Recruitment Status: Not yet recruiting |
Contact Information
1. To assess the efficacy of 8 weeks of excimer laser in treating fingernail psoriasis in a randomized, blinded, right-left comparison trial. Due to slow growth rate of fingernails, final efficacy assessment will be performed at week 16.
a. To compare the mean improvement in target nail mNAPSI score of excimer laser treated hand compared to sham treated hand.
b. To assess the proportion of patients achieving NAPSI 50 and NAPSI 75 at week 16.
c. To assess the proportion of patients with no nail psoriasis at weeks 16.
d. To compare changes from baseline in physicians and patients assessment of nail psoriasis activity .
2. To assess the adverse events associated with excimer laser treatment of nail psoriasis.
a. To compare immediate and delayed symptoms in excimer treated fingers compared to sham treated fingers.
When To See A Doctor
Nail psoriasis is not contagious, and treatment can reduce or help control the symptoms.
If the nails show symptoms of psoriasis or a fungal infection, see a doctor. This is especially important for people who already have a type of psoriasis.
A person may have to try several treatments before finding one that works.
Symptoms can take time to improve, and they may take up to a year to clear. One reason for this is that the nail plate grows very slowly. The symptoms may also return at a later date.
With new drugs appearing on the market, more effective treatments for nail psoriasis may be on the horizon.
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How To Hide Nail Psoriasis
If you feel self-conscious about your nail psoriasis, there are some things you can do to make it less noticeable.
Cosmetic treatments such as nail filing, buffing, and polish can improve the appearance of your nails while they heal. Just avoid fake nails, which may increase the risk of your nail separating from its bed.
What Nail Psoriasis Looks Like
Nail psoriasis causes changes to your fingernails and toenails
This fingernail shows 3 signs of nail psoriasis: Crumbling, roughness, and blood under the nail .
Common signs of nail psoriasis
This nail also has 3 signs of nail psoriasis: Tiny dents in the nail , white discoloration, and lifting .
Most people who have plaque psoriasis develop nail psoriasis
Discoloration , nail lifting from the finger, and a thin line of blood are common signs of nail psoriasis.
Nail psoriasis usually begins years after psoriasis first appears on the skin
This patients nail has 3 common signs of nail psoriasis: Grooves, blood beneath the nail , and lifting of the nail from the finger.
Nail psoriasis can be mild
If you have psoriasis, ridges and a thin line of blood beneath the nail can be signs of nail psoriasis.
Improvement from treatment happens slowly
Nails grow slowly, so it will take 6 months or longer to clear debris, a common sign of nail psoriasis, beneath the nail.
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Epidemiology Of Nail Psoriasis
Psoriatic nail disease occurs in 10-55% of all patients with psoriasis, and approximately 7 million people in the United States have psoriasis . Less than 5% of psoriatic nail disease cases occur in patients without other cutaneous findings of psoriasis. About 10-20% of people with psoriasis also have psoriatic arthritis, and nail changes are seen in 53-86% of patients with psoriatic arthritis.
Psoriasis tends to run in families. In Farber’s questionnaire study of 2100 patients, 36% of patients reported the presence of psoriasis in at least 1 relative. Among siblings, 8% are affected if neither parent has psoriasis. This percentage increases to 16-25% if 1 parent or sibling has the disease, and it reaches up to 75% if both parents are affected. If 1 twin has psoriasis, the other twin is at an increased risk of having psoriasis .
In Scandinavia, the prevalence rate of nail psoriasis for adults with psoriasis approaches 5%. The prevalence increases with the age of the population studied.
Psoriatic nail disease is not associated with mortality. In severe cases, patients may have functional and psychosocial impairments.
Males and females are affected equally by nail psoriasis, and the prevalence of nail psoriasis increases with the age of the population studied.
Changes In Nail Shape Or Thickness
In addition to pitting, you might notice other changes in the texture of your nails. Psoriasis can cause lines called Beaus lines to form across your nails.
Weakness of the structures that support nails can cause your nails to crumble. Nails can also become thicker due to a fungal infection called onychomycosis, which is common in people with psoriasis.
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What Are The Most Common Treatments
The common therapies for nail psoriasis often include the following methods:1
- Topical drugs applied on the nails
- Intralesional drugs injected into the nails
- Conventional systemic drugs that treat the body as a whole
- Biologic systemic drugs that treat the body’s immune system
- Non-drug options
Nail growth is slow, as is the response to treatments. These methods may not reduce symptoms for 12 weeks up to 1 year after starting them. It is important to talk to your doctor about which treatment methods may be right for you.1
Conditions With Similar Symptoms
Nail psoriasis can resemble a fungal infection, such as onychomycosis. This also causes the nails to thicken. Moreover, onychomycosis often occurs alongside nail psoriasis. This can make diagnosis difficult.
Getting a correct diagnosis is important because the treatment for a fungal infection is different from the treatment for nail psoriasis. Anyone with psoriasis and changes in their nails should make sure that their doctor is aware of their psoriasis.
Nail psoriasis does not always cause physical pain, but some people may find it unsightly, and it can cause embarrassment. Treatment can prevent it from worsening.
Treatments include:
- topical medicines, such as creams applied directly to the nails
- systemic medications, which affect the whole body
- intralesional therapies, which involve a doctor injecting medication into the nail bed
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Psoriasis Laser Treatment: How It Works
Excimer laser treatments are performed in the dermatologist’s office. Each session takes only a few minutes. During the treatment, the doctor aims the laser directly at patches of psoriasis. You might feel some warmth at the site or a snapping sensation against the skin.
Excimer lasers aim a high intensity ultraviolet B light dose of a very specific wavelength — 308 nanometers — directly at the psoriasis plaques. Because the laser light never touches the surrounding skin, it reduces the risk of UV radiation exposure. Excimer lasers are used to treat mild-to-moderate psoriasis.
With excimer laser therapy, patients usually have 2 sessions a week for 4 to 10 sessions to get results.Ã
Your doctor will determine your dose of laser light based on the thickness of your psoriasis plaques and your skin color . During the procedure, you will be given dark goggles to protect your eyes.
For Best Results From Treatment
Treating nail psoriasis can be a challenge. It often takes time to treat. To get results, you need to treat your nails as directed and for as long as directed. Some patients need to try a few treatments to find one that works.
The right nail care can help you get the best results from treatment. Youll find out what dermatologists recommend at: 7 easy-to-follow nail care tips that can reduce nail psoriasis
ImagesImages used with permission of the Journal of the American Academy of Dermatology. J Am Acad Dermatol 2013 69:249.
ReferencesCrowley JJ, Weinberg JM, et al. Treatment of nail psoriasis: Best practice recommendations from the Medical Board of the National Psoriasis Foundation. JAMA Dermatol. 2015 Jan 151:87-94.Dogra A, Arora AK. Nail psoriasis: The journey so far. Indian J Dermatol. 2014 Jul 59:319-33.Lin YK, Chang YC, et al. A Chinese herb, indigo naturalis, extracted in oil used topically to treat psoriatic nails: A randomized clinical trial. JAMA Dermatol. 2015 Jun 151:672-4.Manhart R, Rich P. Nail psoriasis. Clin Exp Rheumatol. 2015 Sep-Oct 33:7-13.van der Velden HMJ, Klaassen KMG, et al. Fingernail psoriasis reconsidered: A case-control study. J Am Acad Dermatol 2013 Aug 69:245-52.
All content solely developed by the American Academy of Dermatology
The American Academy of Dermatology gratefully acknowledges the support from Amgen and .
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What Are Your Nail Psoriasis Treatment Options
Many people who have psoriasis also experience changes in their fingernails or toenails. But there are treatments that can help.
Nail psoriasis is the term for changes in your fingernails and toenails that occur as a result of having the autoimmune disease psoriasis. According to the National Psoriasis Foundation, up to 55 percent of people with skin psoriasis also have nail psoriasis.
While it’s not a life-threatening condition, nail psoriasis can affect your quality of life, since it may cause you discomfort and affect your self-esteem. It may also be a clue that you’re at greater risk of developing psoriatic arthritis. Although it cannot be cured, nail psoriasis can be helped with treatment.
How Psoriasis Affects The Nails
Nail psoriasis occurs because psoriasis affects the process of nail formation. People who have nail psoriasis usually have psoriasis on other parts of their body, such as the skin and joints. Rarely does someone have only psoriasis of the nails.
Symptoms of nail psoriasis vary but may include:
- Discoloration of the nail to yellow-brown
- Pitting in the surface of the nails
- Horizontal lines across the nails
- White patches on the nails
- Thickening of the nails
- Nails that separate from the nail bed
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