Although nail psoriasis is common, the results of treatment of nail psoriasis are often disappointing, there is little  information addressing the efficacy of systemic therapies in patients with diffuse and severe nail involvement in the Nail Psoriasisabsence of skin disease. The article in JAMA Archive of Dermatology herein described on the efficacy of low-dose acitretin in isolated nail psoriasis.

Irregular pitting, salmon-colored patches on the nail bed, and onycholysis with erythematous borders, are commonly seen in fingernails. There could be any other abnormalities such splinter hemorrhages, nail-bed hyperkeratosis, nail thickening and crumbling, paronychia, and, rarely, leukonychia, erythema of the lunula, and trachyonychia.

That is why researchers from Department of Dermatology, University of Bologna want to evaluate the therapeutic efficacy of acitretin in patients with isolated nail psoriasis. The acitrecin would be 0.2 to 0.3 mg/kg/d, for 6 months from total of 27 men and 9 women (mean age, 41 years) with nail psoriasis.

They were Antonella Tosti, MD; Carlos Ricotti, MD; Paolo Romanelli, MD; Norma Cameli, MD; Bianca Maria Piraccini, MD who did this experiment. They did Clinical evaluation, Nail Psoriasis Severity Index (NAPSI) and modified NAPSI scores before therapy, every 2 months during therapy, and 6 months after treatment as Main Outcome Measurements. The NAPSI score evaluates presence of signs on the nail bed but not provide information on the severity of involvement in each single nail but rather reflects the overall severity of nail psoriasis. And the modified NAPSI score for the target nail scores severity of nail matrix and nail-bed psoriasis.

The results showed that low-dosage acitretin is well tolerated because none of the patients experienced fragility or paronychia during treatment and only 1 patient developed periungual pyogenic granulomas (which promptly regressed after reducing the drug dosage). It is backgrounded as effects of acitretin on nail psoriasis strongly depend on dosages because these drugs may produce worsening of nail psoriasis with paronychia and nail fragility when used at the dosages recommended for skin psoriasis.

Read complete article about Acitretin for Nail Psoriasis Medication you can find here. All three pages PDF Filetype is provided (source: jama.ama-assn.org).