title: Pustular psoriasis of the nails: treatment and long-term follow-up of 46 patients.
abstract: BACKGROUND
  Pustular psoriasis of the nail apparatus is a common disease that greatly influences the quality of life because of its chronic course and poor response to treatment.
  
  
  OBJECTIVE
  To review the clinical and histopathological features, the response to treatment and the long-term follow-up of 46 patients with pustular psoriasis of the nail unit.
  
  
  METHODS
  Treatments utilized included oral retinoids (n = 12), oral nimesulide (n = 13), topical calcipotriol (n = 15) and topical steroids (n = 18). Retinoids were utilized as first choice in seven patients with involvement of several digits and in five patients with severe relapses, whereas topical calcipotriol, oral nimesulide or topical steroids were utilized in patients with involvement of a single nail. Topical calcipotriol was also prescribed as maintenance therapy in patients who responded to oral treatment. Twenty-five patients were followed for more than 5 years.
  
  
  RESULTS
  Improvement or regression of the lesions was obtained in 23 of 46 patients. Retinoids were effective in six of 12 patients, nimesulide in four of 13, topical calcipotriol in nine of 15 and topical steroids in four of 18. The long-term follow-up showed a complete remission of the disease in only two patients, both affected by pustular psoriasis involving multiple nails. All other patients experienced periodic relapses which were in most cases controlled by regular use of topical calcipotriol.
  
  
  CONCLUSIONS
  Severe cases of pustular psoriasis of the nail are best treated with systemic retinoids. Topical calcipotriol is effective in about 50% of patients with localized disorder and is also useful as maintenance therapy after retinoid treatment.
authors.affiliation: Department of Dermatology, University of Bologna, Via Massarenti 1, 40138 Bologna, Italy.
authors.forename: B M
authors.initials: BM
authors.lastname: Piraccini
authors.forename: A
authors.initials: A
authors.lastname: Tosti
authors.forename: M
authors.initials: M
authors.lastname: Iorizzo
authors.forename: C
authors.initials: C
authors.lastname: Misciali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002117:Calcitriol / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002648:Child; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009260:Nail Diseases / Q000188:drug therapy* / Q000473:pathology; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology; D012176:Retinoids / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D003879:Dermatologic Agents; D012176:Retinoids; C055085:calcipotriene; D002117:Calcitriol