Nail Psoriasis Treatment – National Psoriasis Foundation’s Recommendations


Nail Psoriasis Treatment – Published Guidelines

Nail psoriasis is a burden to many psoriasis patients, is difficult to treat, and has no standardized treatment algorithm. The Medical Board of the National Psoriasis Foundation recently published guidelines for the treatment of nail psoriasis. These treatment recommendations spanned four nail psoriasis scenarios and were based on previous research studies and expert opinion.

Psoriasis Nails

The four nail psoriasis scenarios covered were:

  • Psoriasis limited to the nails who have not had previous therapy
  • Psoriasis limited to the nails for whom topical therapy has failed
  • Psoriasis of the skin and nails
  • Psoriasis of the skin, joints, and nails

Treatment recommendations:

Recommendations for psoriasis limited to the nails who have not had previous therapy (with typically 3-10 nails involved):

  • High-potency corticosteroids alone or in combination with calcipotriol
  • Intralesional corticosteroids

Recommendations for psoriasis limited to the nails for whom topical therapy has failed (with typically 5-10 nails involved and listed in order from most enthusiastic to least enthusiastic recommendation):

  • Adalimumab
  • Etanercept
  • Intralesional corticosteroids
  • Ustekinumab
  • Methotrexate
  • Acitretin

Recommendations for psoriasis of the skin and nails (with typically 8% body surface area and 5-10 nail involvement):

  • Adalimumab, etanercept, or ustekinumab (recommended with high enthusiasm)
  • Methotrexate, acitretin, infliximab, or apremilast

Psoriasis of the skin, joints, and nails (with typically 8% body surface area involvement, history of dactylitis or morning stiffness, and 5-10 nails severely involved and listed in order from highest to lowest recommendations)