Nail and scalp involvement
systemic treatments (classical and biological therapy). J Eur Acad Dermatol Venereol 2011;25:579–86.
7. Zaiac M. The role of biological agents in the treatment of nail psoriasis. Am J Clin Dermatol 2010;11(Suppl 1):27–9.
8. Rich P et al. Baseline nail disease in patients with moderate to severe psoriasis and response to treatment with infiiximab during 1 year. J Am Acad Dermatol 2008; 58:224–31.
9. Luger TA et al. Sustained improvement in joint pain and nail symptoms with etanercept therapy in patients with moderate-to-severe psoriasis. J Eur Acad Dermatol Venereol 2009;23:896–904.
10. Ortonne JP et al. A 24-week randomized clinical trial investigating the efficacy and safety of two doses of etanercept in nail psoriasis. Br J Dermatol 2013;168:1080–7.
11. van den Bosch F, Reece R. Behrens F. Clinically important nail psoriasis improvements are achieved with adalimumab (Humira): results from a large open-label prospective study (STEREO). Ann Rheum Dis 2007;66 Suppl II:421 (Abstract FRI0472).
“The role of the nails as an early marker of enthesitis in the context of psoriatic arthritis has been demonstrated”
(n=663) to 3.5 at week 8 (n=640).18 In a prospective, observational Japanese study in which patients were treated with adalimumab or infliximab – concomitant topical treatment with vitamin D analogues was permitted – the authors observed a significant tendency to reach PSSI 75 in the group treated with adalimumab (90%) compared with the infliximab group (54.5%).19
There have been a few cases of patients with moderate to severe SP in whom ustekinumab at doses indicated in the data sheet showed a rapid improvement in the scalp psoriatic lesions at eight weeks of starting treatment, with high adherence and with a positive impact on quality of life.20
Both nail and scalp psoriasis are characterised by a high impact on quality of life despite a limited extension. In addition, although topical therapy has been used extensively, low efficacy – particularly for nail psoriasis – or low tolerance – more evident for scalp psoriasis – interfere with adherence required for response. Although systemic therapy could potentially be a better alternative for these particular locations, this option has to be carefully balanced with the potential secondary effects.
Accumulated experience regarding conventional systemic therapy is scant in both locations. Biologic therapy seems to offer a new perspective and a promise for better response in some studies. However, more specific studies, as well as a wider evaluation of the pros and cons in safety and efficiency, are needed. l
References 1. van Laborde S, Scher RK. Developments in the treatment of nail psoriasis, melanonychia striata, and onychomycosis. Dermatol Clin 2000;18:37–46.
2. Sánchez-Regaña M et al. Evidence-based guidelines of the Spanish Psoriasis Group on the use of biologic therapy in patients with psoriasis in difficult-to-treat stes (nails, scalp, palms, and soles). Actas Dermosifiliogr 2014; May 19:doi: 10.1016/j.ad
3. Wozel G. Psoriasis treatment in difficult locations: scalp, nails, and intertriginous areas. Clin Dermatol 2008;26:448–59.
4. Tosti A et al. Calcipotriol ointment in nail psoriasis: a controlled double-blind comparison with betamethasone dipropionate and salicylic acid. Br J Dermatol 1998;139:655–9.
5. Scher RK, Stiller M, Zhu YI. Tazarotene 0.1% gel in the treatment of fingernail psoriasis: a double-blind, randomized, vehicle-controlled study. Cutis 2001;68:355–8.
6. Sánchez-Regaña M et al. Nail psoriasis: a retrospective study on the effectiveness of
12. Sola-Ortigosa J, Sánchez-Regaña M, Umbert- Millet P. Psoriasis del cuero cabelludo. Actas Dermosifiligr 2009;100:536–43.
13. van de Kerkhof PCM, Franssen MEJ. Psoriasis of the scalp – diagnosis and management. Am J Clin Dermatol 2001;2:159–65.
14. Mason AR et al Topical treatments for chronic plaque psoriasis of the scalp: a systematic review. Br J Dermatol 2013;169:519–27.
15. Puig L et al. Treatment of scalp psoriasis: Review of the evidence and Delphi consensus of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology. Actas Dermosifiliogr 2010;101:827–46.
16. Ortonne JP et al. Scalp psoriasis: European consensus on grading and treatment algorithm. J Eur Acad Dermatol Venereol 2009;23:1435–44.
17. Menter A et al. Consistency of infliximab response in different body regions for treatment of moderate to severe psoriasis: Results from controlled clinical trials. J Am Acad Dermatol 2008;58:AB120.
18. Thaçi D et al. Adalimumab plus topical treatment (calcipotriol/beta-methasone) in the treatment of moderate to severe psoriasis – Effects on skin, scalp, and nails: Results from BELIEVE. 18th Congress of the European Academy of Dermatology and Venereology (EADV), Berlin, 2009;Abstract P824.
19. Noda S, Mizuno K, Adachi M. Treatment effect of adalimumab and infliximab in Japanese psoriasis patients: results in a single community-based hospital. J Dermatol 2012;39:265–8.
20. Di Cesare A, Fargnoli MC, Peris K. Rapid response of scalp psoriasis to ustekinumab. Eur J Dermatol 2011;21:993–4.
21. Harris RP et al. Current methods of the U.S. Preventive Services Task Force: A review of the process. Am J Prev Med 2001;20:21–35.
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