Systemic biologic agents for the treatment of nail psoriasis include anti-tumor necrosis factor-α (TNF-α), anti-interleukin (IL)-12/23, and anti-IL-17 antibodies.3 Evidence indicates that the onset of response for these agents is around 12 weeks, with continued improvement seen for up to one year, and that all biologic therapies used to treat nail psoriasis are equally efficacious. Studies have also found that infliximab may have a faster onset than other biologic agents, however there is also an increased risk of onychomycosis. Biologic therapies are described in Table 4.

Recent data from a phase 2 study showed ixekizumab, an antibody that targets IL-17, significantly reduced the severity of nail psoriasis compared to placebo.2 Patients who received 75 or 100mg of ixekizumab saw an improvement of their baseline severity score by 63.8% and 52.6%, respectively, after 20 weeks in the study. This was compared to the placebo group, which had a worsening of severity score of 1.7%.  In addition, 30% of patients in the 25 and 75mg-dose groups and 20% of patients in the 100mg-dose group saw complete resolution of their nail psoriasis. By week 48, 79.4% of patients saw improvement in their severity score and 51% experienced complete resolution of their nail psoriasis.

Nail psoriasis is a chronic disease that is associated with pain, obstruction of daily activities, and a decrease in a patient’s QOL.3 Although this condition has proved to be difficult to treat, various topical agents, as well as oral and biologic systemic therapies have demonstrated efficacy in treating nail psoriasis. In a recent study, ixekizumab was found to be efficacious at both treating and resolving nail psoriasis.2

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1.       Maranda EL, Nguyen AH, Lim VM, Hafeez F, Jimenez JJ. Laser and light therapies for the treatment of nail psoriasis. J Eur Acad Dermatol Venereol. 2016 May 26; DOI: 10.1111/jdv.13678.

2.       Langley RG, Rich P, Menter A, et al. Improvement of scalp and nail lesions with ixekizumab in a phase 2 trial in patients with chronic plaque psoriasis. J Eur Acad Dermatol Venereol. 2015 Sep; 29: 1763-1770. DOI: 10.1111/jdv.12996.

3.       Pasch MC. Nail psoriasis: a review of treatment options. Drugs. 2016 April 4; 76(6):675-705. DOI: 10.1007/s40265-016-0564-5.