Onychomycosis in patients of nail psoriasis on biologic therapy: a randomized, prospective open label study comparing Etanercept, Infliximab and Adalimumab

Expert Opin Biol Ther. 2013 May;13(5):625-9. doi: 10.1517/14712598.2013.783561. Epub 2013 Mar 26.


Introduction and objective: The association between patients of psoriasis on anti TNF therapy and onychomycosis has not been explored. The aim of this study was to determine the rate of onychomycosis in patients of psoriasis with nail involvement on anti TNF therapy.

Materials and methods: All patients of psoriasis with nail involvement seen between February 2007 - July 2012 were examined. All the patients with negative nail scrapings for fungus were enrolled. Patients found fit for biologics after investigations were randomly divided into 3 groups (Group A: Infliximab, Group B: Etanercept and Group C: Adalimumab). The patients were followed up every 4 weeks for 24 weeks. Repeat nail scrapings were done at week 24. The results were compared with controls.

Result: In total, 315 (178 males and 137 females) patients were enrolled. The mean age was 37.5 ± 11.4 years. The results for scraping for fungus at the end of 24 weeks were as follows: 33% (33/100) in patients on Infliximab followed by 15.45% (17/110), 13.33% (14/105) in patients on treatment with Etanercept and Adalimumab respectively as compared to 13.89% (25/180) among controls. Onychomycosis in association with nail psoriasis was more common in males.

Conclusion: This study revealed statistically significant association between fungal infections of the nail in patients of psoriasis on treatment with Infliximab.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adalimumab
  • Adult
  • Aged
  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized / adverse effects*
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Biological Therapy / adverse effects*
  • Etanercept
  • Female
  • Humans
  • Immunoglobulin G / adverse effects*
  • Immunoglobulin G / therapeutic use
  • Infliximab
  • Male
  • Middle Aged
  • Nail Diseases / drug therapy
  • Nails / chemistry
  • Nails / pathology
  • Onychomycosis / etiology*
  • Onychomycosis / microbiology
  • Prospective Studies
  • Psoriasis / complications*
  • Psoriasis / drug therapy*
  • Receptors, Tumor Necrosis Factor / therapeutic use
  • Tumor Necrosis Factor Inhibitors*
  • Young Adult


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Tumor Necrosis Factor Inhibitors
  • Infliximab
  • Adalimumab
  • Etanercept