Table 2 – Topical Agents for Nail Psoriasis3

Treatment Comments

Topical Corticosteroids (CS)

– Potent and superpotent CS used


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– QD, BID, or pulse dosing

– Combination therapy with calcipotriol: effective, widely used

– Prolonged use: telangiectasia, atrophy of surrounding skin

– Clinical benefit: 4-6 months

Intralesional CS

– Treatment protocols vary

– Treatment is painful, therefore use in patients with few fingernails involved

– AEs: short-term paresthesia, focal pain, hematoma formation, loss of nail plate, nail-fold atrophy, atrophy of underlying phalanx, rupture of extensor tendon

Vitamin D3 analogs:
– Calcipotriol
– Tacalcitold
– Calcitriol

– Effective as monotherapy and in combination with CS

– Calciportriol: most studied, particularly effective in treating subungual hyperkeratosis, onycholysis, and discoloration

– Calcitriol: limited evidence

Tazarotene

– Use is limited due to AEs

– AEs: erythema, irritation, desquamation, paronychia

Topical Calcineurin Inhibitors
– Cyclosporine
– Tacrolimus

– Tacrolimus: better skin-penetrating capability

– No local or systemic effects

– Long-term use: use: nail may turn yellow with use of cyclosporine in maize oil

– Must homogenize emulsion prior to each application (prevents instability of agent)

Anthralin

– Improves pitting, onycholysis, hyperkeratosis, and thickening of the nail

– AEs: reversible pigmentation of the nail plate

5-Fluorouracil

– Not commonly used due to questionable efficacy and AEs

– AEs: inflammation, infection, discoloration, onycholysis

Other Agents

– Allopurinol, intralesional methotrexate, colloidal silicic acid, and indigo naturalis extract studied

– Not recommended (lack of evidence and insufficient data)