Review Article

Treatment of Nail Psoriasis: Common Concepts and New Trends

Table 1

Topical therapies for treatment of nail psoriasis.

AuthorYear InterventionComparisonTreatment protocol Results LoE [16]

Nakamura et al. [17]201215Clobetasol propionate at concentrations 0.05%, 1%, and 8%Placebo (coat nail lacquer)Twice weekly, for 4 mos51% improvement in treatment group (8% clobetasol more efficient)N/A

Fischer-Levanchini et al. [18]201260.1% tazarotene ointmentOnce daily, under occlusion, for 6 mos88% improvement in NAPSI scores at 6th moN/A

De Simone et al. [19]2012210.1% tazarotene ointmentNo treatment to the other handOnce daily, to the affected nails of a randomly selected hand, for 3 mosStatistically significant improvements in the treated hands at week 12N/A

Tzung et al. [20]2008400.005% calcipotriol + 0.05% betamethasone dipropionate 0.005% calcipotriolCalcipotriol twice daily and calcipotriol + betamethasone once daily for 3 mosSimilar efficacy in both groups, significant reduction of NAPSI scoresB

Sánchez-Regaña et al. [21]2008158% clobetasol in nail lacquer and tacalcitolClobetasol once daily at weekends and tacalcitol at weekdays under occlusion, for 6 mos78% reduction in NAPSI at 6 mosN/A

Rigopoulos et al. [22]2007460.1% tazarotene cream0.05% clobetasol propionate Once daily under occlusion, for 3 mosSimilar efficacy in both groups, significant reduction of NAPSI scoresA2

Regaña et al. [23]2005108% clobetasol in nail lacquerOnce daily, for 3 weeks and twice weekly, for 9 mosReduction of all nail alterations within 1 moN/A

Cannavò et al. [24]20031670% CsA oral solution in maize oilMaize oilFor 3 mosComplete resolution or substantial improvement in CsA group A2

Bianchi et al. [25]2003250.1% tazarotene gelOnce daily, for 3 mos19/25 good clinical responseN/A

Rigopoulos et al. [26]200262Calcipotriol cream + clobetasol propionateCalcipotriol once daily every weeknight and clobetasol once daily every weekend, for the first 6 mos and twice weekly clobetasol for the 2nd 6 mosReduction at subungual hyperkeratosis: 72.3% at 6 mos and 81.2% at 12 mosN/A

Scher et al. [27]2001310.1% tazarotene gel Vehicle gelOnce daily, for 6 mos Significant improvement of onycholysis and pitting in tazarotene groupA2/B

de Jong et al. [28]1999571% 5-FU in permeation enhancer lotion (Belanyx)Belanyx (urea and propylene glycol)Once daily, for 3 mosSignificant improvements with both preparationsA2

Baran and Tosti [29]1999188% clobetasol nail lacquerPlacebo Once daily in the first week, from 2nd week onwards 2-3 times weekly, for up to 9 mosClear improvement in 80%, complete resolution in 22% of patients in the treatment armB

Tosti et al. [30]199858Calcipotriol ointmentBetamethasone propionate + salicylic acidTwice daily, for up to 5 monthsCalcipotriol as effective as the combination of topical steroid and salicylic acid (49% versus 51% reduction of subungual hyperkeratosis in fingernails at 6 mos)B

Yamamoto et al. [31]1998200.4–2% anthralin in petrolatum Once daily, for 5 mosEffective in 12/20 patients, particularly in onycholysis and subungual hyperkeratosisN/A

Fredriksson [32]1974201% 5-FU solution Twice daily, for up to 6 mosConsiderable improvement in 17/20 patients, 75% reduction of symptoms compared to baselineN/A

: number of patients.
mo: month.
N/A: not applicable.
NAPSI: nail psoriasis severity index.
CsA: cyclosporine.
5-FU: 5-fluorouracil.
LoE: level of evidence (A2: randomized, double-blind, controlled trial of good quality, B: randomized controlled trial of poor quality).