Effectiveness of systemic treatment agents on psoriatic nails: a comparative study

J Drugs Dermatol. 2013 Sep;12(9):1039-43.


Background: Nails, one of the most visible sites of body, are frequently involved in psoriasis and accepted as the most difficult site for topical treatment because of their anatomical structure. Healing of the psoriatic nails usually occurs when systemic therapy is initiated to treat severe skin psoriasis or joint involvement, but sometimes systemic therapy is essential for severe nail psoriasis, although Psoriasis Area and Severity Index (PASI) score is low or none of the joints are affected. In this case, knowing which systemic agent is most potent on nail findings is important.

Aim: We aimed to evaluate the effect of systemic antipsoriatic agents on nail findings.

Methods: Eighty-seven psoriatis patients with fingernail involvement who required systemic treatment but had not used any systemic treatment in the previous 12 weeks were included in this study. Different systemic treatment agents were given to patients, considering factors such as age, sex, and joint involvement, but not nail involvement. The control group was recruited from psoriatis patients with nail involvement who were not receiving any systemic treatment. Baseline and week 16 Nail Psoriasis Severity Index (NAPSI) and PASI were detected in all groups. At the end of the study, effects of the agents on both PASI and NAPSI were compared statistically.

Results: Patients were divided into 5 groups to receive either: 1) methotrexate, 2) narrow-band ultraviolet B phototherapy, 3) biological agents, 4) acitretin, or 5) no treatment (control group). None of the conventional treatment agents caused any significant difference on NAPSI at the end of week 16 compared with control group, although PASI decreased significantly. Rate of NAPSI changes were more prominent in the biological treatment group, and a statistically significant difference was detected when compared with the control group.

Publication types

  • Comparative Study

MeSH terms

  • Acitretin / therapeutic use*
  • Adalimumab
  • Adult
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Biological Factors / therapeutic use*
  • Combined Modality Therapy
  • Dermatologic Agents / therapeutic use*
  • Etanercept
  • Female
  • Humans
  • Immunoglobulin G / therapeutic use
  • Infliximab
  • Keratolytic Agents / therapeutic use*
  • Male
  • Methotrexate / therapeutic use*
  • Middle Aged
  • Nail Diseases / drug therapy*
  • Nail Diseases / pathology
  • Nails / pathology
  • Onycholysis / drug therapy
  • Onycholysis / pathology
  • Phototherapy
  • Psoriasis / drug therapy*
  • Psoriasis / pathology
  • Receptors, Tumor Necrosis Factor / therapeutic use


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Biological Factors
  • Dermatologic Agents
  • Immunoglobulin G
  • Keratolytic Agents
  • Receptors, Tumor Necrosis Factor
  • Infliximab
  • Adalimumab
  • Acitretin
  • Etanercept
  • Methotrexate