Treatment of Nail Psoriasis: Common Concepts and New Trends

Table 2

Systemic therapies for treatment of nail psoriasis.

Author	Year	𝑛	Intervention	Comparison	Treatment protocol	Results	LoE [16]
Sánchez-Regaña et al. [44]	2011	84	Classical treatment	Biological treatment	Classical: acitretin, MTX, CsA, PUVA, NUVB, REPUVA, RENUVB; Biological: infliximab, efalizumab, etanercept, adalimumab, for up to 8 mos	Significant reductions in NAPSI scores with all antipsoriatics, except for NUVB; significantly greater with CsA and biological as infliximab and adalimumab at 3 and 6 mos	N/A
Gümüşel et al. [45]	2011	37	MTX 15 mg/week, sc	CsA 5 mg/kg, po	MTX decreased to 10 mg/week after 3 months, for total 6 mos; CsA decreased to 2.5–3.5 mg/kg/day after 3 mos, for total 6 mos	Similar efficacy in both groups: reduction in NAPSI scores: 43% in MTX group, 37% in CsA group	A2
Tosti et al. [46]	2009	36	Acitretin	—	0.2–0.3 mg/kg/day, for 6 mos	41% reduction in NAPSI scores	N/A
Syuto et al. [47]	2007	16	CsA-MEPC	—	3 mg/kg/day and reduced to 1.5 mg/kg/day in responders	Improvement in over 90% of patients	N/A
Feliciani et al. [48]	2004	54	CsA	CsA + calcipotriol cream	CsA 3.5 mg/kg/day, in both groups; calcipotriol cream twice daily, for 3 mos	79% improvement in combination group and 47% improvement in CsA alone	N/A
Mahrle et al. [49]	1995	210	CsA	Etretinate	Phase 1: randomly assigned for CsA (2.5–5 mg/kg/day) or etretinate (0.5–0.75 mg/kg/day) for 10 weeks; Phase 2: etretinate group discontinued treatment and continued with topical dithranol; CsA group either tapered or discontinued and replaced with topical dithranol for 12 weeks	After phase 1: significant alleviation of nail involvement in both groups and after phase 2: statistically significant decrease in nail involvement for tapered cyclosporine group	B

𝑛: number of patients.
NAPSI: nail psoriasis severity index.
N/A: not applicable.
sc: subcutaneous.
po: peroral.
MTX: methotrexate.
CsA: cyclosporine.
MEPC: microemulsion preconcentrate.
LoE: level of evidence (A2: randomized, double-blind, controlled trial of good quality, B: randomized controlled trial of poor quality).