title: Treatment of nail psoriasis: best practice recommendations from the Medical Board of the National Psoriasis Foundation.
abstract: OBJECTIVE
  Nail psoriasis can be difficult to treat and has a significant effect on quality of life. Relatively few controlled trials evaluating treatments for nail psoriasis have been published. There is an unmet need for treatment recommendations to guide therapeutic decisions.
  
  
  OBJECTIVE
  To develop treatment recommendations for nail psoriasis from the Medical Board of the National Psoriasis Foundation.
  
  
  METHODS
  A PubMed search for publications on nail psoriasis treatments was performed from January 1, 1947, through May 11, 2014, without language restrictions.
  
  
  RESULTS
  Treatment recommendations for 4 clinical nail psoriasis scenarios were developed based on the evidence reviewed in this study and expert opinion of the Medical Board of the National Psoriasis Foundation. Treatment of nail psoriasis should balance consideration of the extent of skin disease, psoriatic arthritis, and severity of nail disease with concomitant impairment of quality of life. All patients should be evaluated for onychomycosis because this may complicate psoriatic nail disease. For disease limited to the nails, high-potency topical corticosteroids with or without calcipotriol are initial options. For patients with significant nail disease for whom topical therapy has failed, treatment with adalimumab, etanercept, intralesional corticosteroids, ustekinumab, methotrexate sodium, and acitretin are recommended. For patients with significant skin and nail disease, adalimumab, etanercept, and ustekinumab are strongly recommended, and methotrexate, acitretin, infliximab, and apremilast are recommended. Finally, for a patient with significant nail, skin, and joint disease, adalimumab, etanercept, ustekinumab, infliximab, methotrexate, apremilast, and golimumab are recommended.
  
  
  CONCLUSIONS
  Treatment of nail psoriasis poses a clinical challenge. Clinical trial data are limited, and results are reported inconsistently, making comparisons among treatment options difficult. The treatment recommendations from the Medical Board of the National Psoriasis Foundation will help guide treatment decisions for clinicians who are treating patients with nail psoriasis.
authors.affiliation: Bakersfield Dermatology, Bakersfield, California.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Crowley
authors.affiliation: Department of Dermatology, Mt Sinai Health System, New York, New York.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Weinberg
authors.affiliation: Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
authors.forename: Jashin J
authors.initials: JJ
authors.lastname: Wu
authors.affiliation: National Psoriasis Foundation, Portland, Oregon.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Robertson
authors.affiliation: Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
authors.forename: Abby S
authors.initials: AS
authors.lastname: Van Voorhees
mesh_terms: D015535:Arthritis, Psoriatic / Q000188:drug therapy* / Q000473:pathology; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D009260:Nail Diseases / Q000188:drug therapy* / Q000473:pathology; D014009:Onychomycosis / Q000150:complications / Q000175:diagnosis; D011565:Psoriasis / Q000188:drug therapy* / Q000473:pathology; D011788:Quality of Life; D012720:Severity of Illness Index
chemical_list: D003879:Dermatologic Agents