title: Nail psoriasis: combined therapy with systemic cyclosporin and topical calcipotriol.
abstract: BACKGROUND
  Nail psoriasis is a common problem in psoriatic patients and often it is difficult to cure. Several treatments have been proposed in the last decade using new molecules like vitamin-D analog and/or immunosoppressive drugs both systemically and locally.
  
  
  OBJECTIVE
  Our goal was to evaluate a combination of cyclosporin and topical calcipotriol cream versus cyclosporin alone in a matched group of patients treated with cyclosporin alone.
  
  
  METHODS
  Fifty-four patients affected by severe psoriasis and nail involvement were selected and matched for severity of nail involvement, sex, age, and cyclosporin dosage. Group A included 21 patients treated with cyclosporin alone (3.5 mg/kg/day) for three months. Group B included 33 patients treated with the same cyclosporin dosage plus, for the same time, topical application of calcipotriol cream twice a day. Evaluation for clinical improvement was the personal feeling of the patient after three months, while clinical appearance of the lesions was evaluated by the same dermatologist using digital pictures and who was blind as to the treatment of the patient. A score ranging from + to +++ was used in order to evaluate the improvement, and data were statistically evaluated with the Wilcoxon test.
  
  
  RESULTS
  Both cyclosporin alone and a combination of cyclosporin with topical calcipotriol twice a day were useful for treating nail psoriasis after three months of therapy although the combined therapy showed a better overall result in both mild and severe nail psoriasis. Improvement of the clinical appearance of the nail lesions was seen in about 79% of patients in group B (p < or = 0.0004) versus about 47% of patients in group A (p < or = 0.15).
  
  
  CONCLUSIONS
  In patients with severe involvement of nail psoriasis we suggest the use of a combination of topical calcipotriol twice a day with systemic treatment such as cyclosporine.
authors.affiliation: Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy. feliciani@rm.unicatt.it
authors.forename: Claudio
authors.initials: C
authors.lastname: Feliciani
authors.forename: Anna
authors.initials: A
authors.lastname: Zampetti
authors.forename: Pietro
authors.initials: P
authors.lastname: Forleo
authors.forename: Luca
authors.initials: L
authors.lastname: Cerritelli
authors.forename: Paolo
authors.initials: P
authors.lastname: Amerio
authors.forename: Gianluca
authors.initials: G
authors.lastname: Proietto
authors.forename: Antonio
authors.initials: A
authors.lastname: Tulli
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Amerio
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D002117:Calcitriol / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D016572:Cyclosporine / Q000008:administration & dosage*; D003879:Dermatologic Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009260:Nail Diseases / Q000188:drug therapy*; D011565:Psoriasis / Q000188:drug therapy*; D016037:Single-Blind Method
chemical_list: D003879:Dermatologic Agents; C055085:calcipotriene; D016572:Cyclosporine; D002117:Calcitriol