Nail Psoriasis In Patients Research Articles

Nailfold capillaroscopy for diagnosis of onychodystrophies: A prospective cross-sectional study

Nail diseases are often associated with significant physical and psychosocial burden, but diagnosis is challenging due to non-specific clinical and histological findings. Nail fold capillaroscopy has been studied for diagnosis of systemic diseases, but studies on nail diseases are lacking. Our objectives were to characterize and compare capillary changes in a set of nail conditions vs. controls, between nail groups, and based on demographic/clinical criteria. This was a prospective cross-sectional study of patients with nail psoriasis, onychomycosis, idiopathic onycholysis, brittle nail syndrome, nail lichen planus, retronychia, other nail conditions, and no nail findings (controls) undergoing capillaroscopy imaging/analysis. Nail psoriasis vs. control patients demonstrated decreased capillary length/density and increased abnormal capillaries, with higher frequency in older, male patients. Onychomycosis was associated with increased meandering capillaries compared to controls, nail psoriasis, and nail lichen planus. Retronychia is associated with increased disorganized polymorphic capillaries compared to controls and onychomycosis. Limitations include small sample size for certain nail conditions and small numbers of nail psoriasis patient with psoriatic arthritis. Our findings highlight nailfold capillaroscopy as a potentially quick, cost-effective, and non-invasive imaging modality, as an adjunct for diagnosis and treatment initiation for patients with onychodystrophies.

Rapid response of nail psoriasis to secukinumab in patients with moderate to severe psoriasis after 12 weeks of treatment with a total of 24 weeks of follow-up.

Nail psoriasis, a subtype of psoriasis, can cause significant pain, disability, and reduced quality of life. Despite the established efficacy of anti-IL17 secukinumab in improving skin psoriasis, there is a lack of clinical trials focusing on nail psoriasis as primary endpoint. This study aims to investigate the efficacy of secukinumab in treating nail psoriasis in patients with moderate to severe psoriasis. We prospectively recruited patients newly diagnosed with moderate to severe psoriasis in single centre from January 2021 to January 2022 who were treated with secukinumab. A total of 16 patients consisting of 9 males and 7 females were included. Their mean age was 38.88 ± 10.29 years. They had an average initial Nail Psoriasis Severity Index (NAPSI) score of 45.06 ± 20.39 and an average NAPSI score at 12 weeks of 8.94 ± 13.50, showing a significant (p < 0.05) decrease of NAPSI score after 12 weeks of secukinumab treatment. After 24 weeks of treatment, NAPSI score was decreased to 5.12 ± 8.52. Secukinumab rapidly improved nail psoriasis after 12 weeks of treatment, with further enhancement at 24 weeks, suggesting its potential as a potent therapeutic option for nail psoriasis.

43878 Bimekizumab versus secukinumab for the treatment of nail psoriasis in patients with moderate to severe plaque psoriasis: Results from the BE RADIANT phase 3b trial

43878 Bimekizumab versus secukinumab for the treatment of nail psoriasis in patients with moderate to severe plaque psoriasis: Results from the BE RADIANT phase 3b trial

Nail Psoriasis Quality Of Life Scale 10 (Npq10) As A Predictor Of Quality Of Life In Nail Psoriasis Patients

Nail psoriasis can affect the patient's quality of life, so to evaluate the quality of life in patients with skin diseases in general, the Dermatology Quality of Life Index (DLQI) can be used. The questionnaire was unable to distinguish the impact on quality of life caused by nail abnormalities or skin lesions, so a special scoring system was needed to evaluate the quality of life for nail psoriasis patients with the Nail Psoriasis Quality of Life Scale 10 (NPQ10). To find the relationship between the severity of nail posirais based on Nail Psoriasis Severity Index (NAPSI) score with DLQI and NPQ10. The total respondents were 20 people with a diagnosis of nail psoriasis who came to the Dermatovenereology Outpatient Clinic of Dr. Moewardi General Hospital, Surakarta from April-June 2020. We took photography and dermoscopy of fingernails and toes and then calculated the NAPSI score. All respondents filled out the DLQI and NPQ10 questionnaires. Pearson's (r) correlation test was used to find the relationship between the mean and standard deviations of NAPSI and DLQI and NPQ10. We also tested the correlation between DLQI and NPQ10. The data significance value was declared significant if p &lt;0.05. The results of the correlation test between NAPSI scores with DLQI and NPQ10 showed a statistical relationship, where the correlation value between NAPSI and DLQI was slightly more significant than NPQ10 (r = 0.948: r = 0.877; p &lt;0.05). The mean value of DLQI and NPQ10 in women was higher than men (14.12 ± 8.21: 11.5 ± 8.29 and 11.5 ± 3.58: 8.16 ± 4.52) with a correlation test value of DLQI and NPQ10 is r = 0.888, p &lt;0.05. We found that the association between NAPSI correlates more significantly with DLQI than NPQ10. This may be due to some questions that do not reflect the daily activities of our study subjects, but NPQ10 score in women is higher than men where the quality of life for nail psoriasis is also influenced by gender.

32827 Simultaneous nail and skin clearance in 5 ixekizumab head-to-head trials for moderate-to-severe psoriasis and psoriatic arthritis

Background: Lifetime incidence of nail psoriasis in patients with moderate-to-severe psoriasis (PsO) is 80-90%, and up to 55% of patients have nail psoriasis at any given time. Nail psoriasis is even more prevalent in patients with psoriatic arthritis (PsA). Complete psoriasis clearance is an achievable therapeutic goal, and ideally should include resolution of psoriasis within nails. Here, we assessed simultaneous skin and nail clearance in patients with psoriasis across 5 head-to-head trials comparing ixekizumab with other biologics. Methods: Data were assessed in patients with PsO (with or without PsA) with nail psoriasis at baseline from the IXORA-R, IXORA-S, UNCOVER-2, UNCOVER-3, and SPIRIT-H2H trials. IXE patients received IXEQ2W to week 12, and IXEQ4W beyond week 12. Complete skin improvement was assessed by PASI 100, and complete nail resolution was assessed by either PGA-F (0) (IXORA-R) or NAPSI (0) (all other trials). Treatment comparisons were evaluated using the Cochran Mantel Haenszel test. Nonresponder imputation was used for missing data. Results: Ixekizumab achieved numerically greater simultaneous skin and nail clearance than etanercept (UNCOVER-2: ixekizumab = 6.8%, etanercept = 0.4%, P < .001, UNCOVER-3: ixekizumab = 10.5%, etanercept = 0.8%, P < .001) at 12 weeks; guselkumab (ixekizumab = 37.9%, guselkumab = 28.0%, P = .079), ustekinumab (ixekizumab = 28.6%, ustekinumab = 8.6%, P < .001), and adalimumab (ixekizumab = 45.9%, adalimumab = 17.1%, P = .006) at 24 weeks; and ustekinumab (ixekizumab = 40.5%, ustekinumab = 16.2%, P < .001), and adalimumab (ixekizumab = 51.4%, adalimumab = 22.0%, P = .007) at 52 weeks. Conclusions: Across five head-to-head trials, ixekizumab-treated patients had higher rates of simultaneous complete skin and nail clearance compared with etanercept, guselkumab, ustekinumab and adalimumab, thereby reinforcing ixekizumab’s ability to achieve high levels of efficacy.

Simultaneous Nail and Skin Clearance in Ixekizumab Head-to-Head Trials for Moderate-to-Severe Psoriasis and Psoriatic Arthritis.

IntroductionThe lifetime incidence of nail psoriasis in patients with psoriasis is 80–90%, with 23–27% of patients having nail psoriasis at any given time. Nail psoriasis is even more prevalent in patients with comorbid psoriatic arthritis. Complete psoriasis clearance, an achievable therapeutic goal, should ideally include the resolution of nail psoriasis. Here, we assessed simultaneous skin and nail clearance in patients with psoriasis across five head-to-head trials comparing ixekizumab with other biologics.MethodsData were assessed in patients with moderate-to-severe psoriasis (with or without psoriatic arthritis) with nail psoriasis at baseline from the IXORA-R, IXORA-S, UNCOVER-2, UNCOVER-3, and SPIRIT-H2H trials. Ixekizumab patients received IXEQ2W to week 12 and IXEQ4W beyond week 12. PASI 100 depicted complete skin clearance, and PGA-F 0 (IXORA-R) or NAPSI 0 (all other trials) depicted complete nail clearance. Treatment comparisons were evaluated using the Cochran-Mantel-Haenszel test. Non-responder imputation was used for missing data.ResultsIxekizumab achieved significantly greater simultaneous skin and nail complete clearance than etanercept (UNCOVER-2: p < 0.001 and UNCOVER-3: p < 0.001) at week 12, demonstrating an efficacious and rapid response. Across all five head-to-head trials, ixekizumab achieved a high rate of simultaneous skin and nail clearance (range: 28.6–45.9% of patients) by week 24 that was maintained up to week 52 (range: 40.5–51.4% of patients). Ixekizumab achieved numerically greater simultaneous complete clearance than guselkumab at week 24 (p = 0.079), but statistically significant greater simultaneous clearance compared to ustekinumab (p < 0.001) and adalimumab (p = 0.006) at week 24 and week 52 (p < 0.001 and p = 0.007, respectively).ConclusionIn five head-to-head trials, ixekizumab-treated patients had higher rates of simultaneous complete skin and nail clearance compared to etanercept, guselkumab, ustekinumab, and adalimumab, thereby reinforcing ixekizumab’s ability to achieve high levels of efficacy in multiple domains of psoriatic disease.Trial registrationNCT01474512, NCT01597245, NCT01646177, NCT03573323, NCT02561806, and NCT03151551.

25597 Improvements in scalp and nail psoriasis with apremilast treatment in patients with moderate to severe plaque psoriasis with and without a history of psoriatic arthritis

Background: Apremilast 30 mg BID (APR) demonstrated efficacy in scalp and nail psoriasis in patients with plaque psoriasis. Efficacy has not been investigated/reported in patients with comorbid psoriatic arthritis (PsA). Here, we evaluated APR on scalp and nail psoriasis in patients with and without dermatology investigator-reported PsA history in moderate-to-severe psoriasis from ESTEEM 1&2 (∼70% biologic-naive) and LIBERATE (100% biologic-naive) trials.

25851 Efficacy of secukinumab in managing axial manifestations and nail psoriasis in patients with psoriatic arthritis: Results from the MAXIMISE trial

Introduction: Psoriatic arthritis (PsA) affects approximately 20-30% of patients with psoriasis, 25-70% of whom may have axial disease, and up to 80% have nail lesions. Nail involvement has been reported as a predictor of PsA. We report efficacy and safety of secukinumab through Week 52 from MAXIMISE (NCT02721966), first randomized controlled trial evaluating efficacy of a biologic in the treatment of axial manifestations in PsA.

IL-17A in the treatment of nail psoriasis

BACKGROUND: Psoriasis is an inflammatory skin disease that significantly worsens the quality of the patients life. With vulgar psoriasis, the most common form of the disease, nail damage is observed in more than 50% of cases.&#x0D; AIMS: To evaluate the efficacy and tolerability of secukinumab in the treatment of nail psoriasis (psoriatic onychodystrophy) in real clinical practice.&#x0D; MATERIALS AND METHODS: The study was carried out on the basis of the Clinic for Skin and Venereal Diseases. V.A. Rakhmanov Sechenov University. The participants were 12 patients diagnosed with psoriasis, aged 29 to 60 years. All patients were diagnosed with a severe degree, 2 (16.7%) patients ― psoriatic erythroderma, 10 (83.3%) ― psoriasis vulgaris, all studied patients had nail plate lesions. All patients were treated with a genetically engineered biological drug ― an IL-17A inhibitor secukinumab (Cosentix), 300 mg subcutaneously once a week (5 injections), followed by a maintenance dose of 300 mg once a month. The course of therapy was 20 weeks (9 injections). Assessment of the severity of nail psoriasis and the effectiveness of therapy was carried out using indices: NAPSI (index of the degree of damage to the nail plates), DLQI (dermatological index of quality of life), which were studied in dynamics before treatment and after 20 weeks of treatment.&#x0D; RESULTS: The NAPSI index was 25.33.4 points before treatment, and at week 20 it decreased to 2.20.7 points. These results demonstrate a regression of clinical manifestations by more than 80% from the initial state of the nails. When assessing the dermatological index of quality of life (DLQI), it was found that in the study group of patients before the start of treatment, it was 27.42.1 points, which reflected a strong negative effect of psoriasis on the quality of life of patients. After treatment, this indicator was 3.10.5 points among all patients. No patient experienced any side effects from the therapy.&#x0D; CONCLUSIONS: Secukinumab is a highly effective and safe drug for the treatment of nail psoriasis in patients with vulgar psoriasis and psoriatic erythroderma and contributes to improve the quality of the patients life.

Correlation between nail psoriasis severity index score with quality of life in nail psoriasis

Background: Psoriasis is a recurring chronic inflammatory disease, which can involve the skin, nails and joints. Nail psoriasis occurred in 50% of psoriasis patients. Nail psoriasis can interfere with the quality of life (QoL) due to its physical, mental, and social impacts. To determine the correlation between Nail Psoriasis Severity Index (NAPSI) score and QoL in nail psoriasis patients.Methods: This was a correlative analytical study with a cross-sectional approach that involved nail psoriasis subjects aged ≥18 years. Data accessed from the recording of basic data. The examination of subjects included an assessment of NAPSI scores and the Nail Psoriasis Quality of Life (NPQ10) questionnaire. Statistical analyses were performed using Pearson’s correlation coefficients, with P&lt;0.05 was considered statistically significant.Results: A total of 26 subjects with nail psoriasis, with the highest proportion, were female (57.7%), age group of 48–57 years (34.6%), duration of psoriasis &gt;5 years (76.9%), NAPSI score 81-100 (30.8%), the mean NAPSI score was 89.42±32.01, and the mean NPQ10 score was 6.96±3.30. There was a significant moderate positive correlation between the NAPSI score and QoL (r=0.632, p=0.001).Conclusion: The higher the NAPSI scores, the worse the quality of life for nail psoriasis patients.

Preliminary Validation of the Severity of Nail Psoriasis Score (SNAPS) for the Assessment of Nail Psoriasis in Patients With Psoriatic Arthritis

Background: Psoriatic nail dystrophy is infrequently assessed in routine care and observational cohorts due to the lack of a feasible validated outcome measure. Objective: To assess the measurement properties of the “Severity of NAil Psoriasis Score” (SNAPS) in PsA. Methods: Nail photography was performed on prospectively recruited patients at baseline and 6 months. The modified Nail Psoriasis Severity Index (mNAPSI) and Physician Nail Visual Acuity Scale (PhNVAS) were comparator instruments for construct validity. Reliability and feasibility were assessed using intra-class correlations (ICCs) and timed scoring. Responsiveness was assessed by correlating the changes in SNAPS, mNAPSI and PhNVAS. Retrospective data from the Bath PsA database was further utilized to assess responsiveness. Results: 21 patients participated in the prospective validation at baseline. Inter- and intra-rater reliability of SNAPS were 0.94 and 0.93-0.96 (p ≤ 0.005). Mean times required to score SNAPS and mNAPSI were 59 and 136 seconds. There were strong correlations between SNAPS and mNAPSI (r = 0.95, p &lt; 0.001) and PhNVAS (r = 0.77, p &lt; 0.001) at baseline. There was a significant reduction in the mNAPSI and SNAPS (p &lt; 0.005) at 6 months and a strong correlation between the change in SNAPS and mNAPSI (rho = 0.838, p &lt; 0.001). Historical data from 57 patients commenced on Etanercept were evaluated. Mean SNAPS reduced from 3.6 to 2.0 at 3 months and 1.2 at 6 months (p &lt; 0.05). Change in SNAPS correlated with changes in Psoriasis Area Severity Index and Dermatology Quality of Life at 3 and 6 months (r≥0.510; p ≤ 0.003). Conclusion: SNAPS is a feasible, reliable and responsive outcome instrument for psoriatic nail dystrophy.

13771 Comparison of ixekizumab and adalimumab in the treatment of nail psoriasis in psoriatic arthritis patients with moderate to severe psoriasis: 24-week results from a multicenter, randomized, open-label, rater-blinded study (SPIRIT-H2H)

Objective: Nail psoriasis is common in patients with psoriatic arthritis (PsA) and plaque psoriasis (PsO), causing pain and impaired hand mobility. This analysis evaluated the efficacy of two biologic disease-modifying antirheumatic drugs (bDMARDs), ixekizumab and adalimumab, for treating nail psoriasis in patients with active PsA and moderate to severe PsO (Psoriasis Area and Severity Index score ≥12, static Physicians Global Assessment score ≥3 and body surface area involvement ≥10%).

Management of nail psoriasis.

Nail involvement is estimated to affect 80-90% of patients with psoriasis at some point in their lives and is often associated with severe disease. Patients with nail involvement experience pain, functional impairment and social stigma, with significant restriction of daily activities and quality of life. Nail psoriasis is also considered a risk factor for the development of psoriatic arthritis (PsA). Management of nail psoriasis is deemed challenging and as a result, it is often left untreated by physicians. Assessing the severity of nail disease can also be difficult in clinical practice. While the Nail Psoriasis Severity Index is used widely in trials, it is time-consuming and rarely used in the clinic, highlighting the need to develop a simplified disease severity score for nail psoriasis. All patients should be advised to keep their nails short, wear gloves for wet and dirty work, and regularly apply emollient to the nail folds and nail surface. Patients with mild nail psoriasis, without signs of severe cutaneous psoriasis or PsA, may benefit from topical treatment, while systemic treatment is indicated in patients with severe nail involvement. Evidence suggests that all anti-tumour necrosis factor (TNF)-α, anti-interleukin (IL)-17, and anti-IL-12/23 antibodies available for plaque psoriasis and PsA are highly effective treatments for nail psoriasis. This article aims to provide an up-to-date review of the therapeutic options currently available for the management of nail psoriasis in patients with or without skin psoriasis. Therapeutic options for the management of nail psoriasis in children will also be discussed.

Clinical parameters associated with severity of nail psoriasis and therapeutic efficacy.

Nail involvement is common in psoriasis patients, however, there are few detailed studies of clinical parameters related to disease severity and therapeutic efficacy. Our retrospective study aimed to describe the prevalence and clinical characteristics in nail psoriasis patients and determine possible associations between multiple clinical parameters and disease severity or therapeutic efficacy. A total of 89 nail psoriasis patients were included and investigated using dermoscopy. The Nail Psoriasis Severity Index (NAPSI) and the Nijmegen-Nail Psoriasis Activity Index tool (N-NAIL) were used to measure the severity and improvement of nail psoriasis. Severity and efficacy-related parameters were also analysed. Subungual hyperkeratosis (94.4%) was the most commonly observed nail feature. Coexistence of pitting and leukonychia, transverse grooves and thickening were more commonly observed in juveniles than adults. Patients with more severe nail psoriasis were more likely to have more nails affected and develop discolouration. The efficacy of treatment after fixed intervals of treatment was analysed. Most clinical parameters were not related to therapeutic efficacy, including disease duration, age at onset and number of nail signs. However, after six months of treatment, the presence of transverse grooves was shown to be associated with better efficacy. Based on comparison of NAPSI and N-NAIL scores relative to the first visit, the presence of transverse grooves, longitudinal ridges or discolouration were associated with better efficacy. Clinicians should be aware of the clinical parameters related to severity and the use of therapeutic efficacy in choosing individualized treatment and predicting prognosis.

Recommendations for treatment of nail psoriasis during the COVID-19 pandemic.

The novel coronavirus disease 2019 (COVID‐19) pandemic has resulted in a paradigm shift in disease management. Since immunosuppression may cause increased susceptibility to COVID‐19, there is uncertainty as to whether systemically treated nail psoriasis patients are at increased infection risk. While specific data on nail psoriasis treatments and COVID‐19 is lacking, we present clinical trial data on rates of upper respiratory infections, nasopharyngitis, viral infection, pneumonia and overall infections. Some systemic medications and biologics are associated with increased in infections risk compared to placebo in clinical trials. However, this data should be regarded cautiously since clinical trials on nail psoriasis, particularly controlled studies, are lacking. Our recommendations may be helpful in guiding physicians managing nail psoriasis patients during the COVID‐19 pandemic.

Ixekizumab and Ustekinumab Efficacy in Nail Psoriasis in Patients with Moderate-to-Severe Psoriasis: 52-Week Results from a Phase 3, Head-to-Head Study (IXORA-S).

IntroductionPatients with plaque psoriasis often have nail psoriasis, which is difficult to treat. Ixekizumab (IXE) and ustekinumab (UST) are biologics with established efficacy in nail psoriasis. We present post hoc data from a head-to-head trial of IXE and UST (IXORA-S) to examine the efficacy in nail psoriasis in patients with moderate-to-severe plaque psoriasis over 52 weeks.MethodsIn IXORA-S, randomised patients received IXE (N = 136) or UST (N = 166) per label for 52 weeks. Eighty-four (61.8%) and 105 (63.3%) of the patients treated with IXE or UST, respectively, had baseline fingernail psoriasis (Nail Psoriasis Severity Index [NAPSI] > 0); of these, 54 (64.3%) and 63 (60.0%) patients, respectively, had significant baseline fingernail psoriasis (defined as NAPSI ≥ 16 with ≥ 4 fingernails involved). The proportion of patients achieving NAPSI = 0, a NAPSI score change from baseline and correlations in Psoriasis Area of Severity Index (PASI) and NAPSI improvement over 52 weeks were examined.ResultsProgressive improvement occurred in both treatment groups over 52 weeks. Statistically significantly more patients achieved NAPSI = 0 with IXE versus UST by week 16–20, and the proportions continued to increase through week 52 among patients with baseline nail psoriasis (61.9 vs. 28.6%, respectively; P < 0.001), including those with significant nail psoriasis (57.4 vs. 17.5%, respectively; P < 0.001). Similar results were observed for NAPSI score improvement from baseline to week 52. Interestingly, the presence of nail psoriasis was associated with lower skin response with UST but not with IXE.ConclusionsIxekizumab was superior to UST in the clearance of nail psoriasis, with earlier improvement continued through 52 weeks regardless of baseline nail severity.Trial RegistrationClinicalTrials.gov identifier; NCT02561806.

Psoríase ungueal: da Identificação a abordagem profissional

A Psoríase é dermatose autoimune que atinge aproximadamente de 3% da população mundial, sendo que cerca de 80% dos portadores apresentam o acometimento ungueal. Atualmente não existem trabalhos propondo uma abordagem podológica no tratamento de portadores de Psoríase ungueal. Desta maneira o objetivo deste trabalho além de preencher esta lacuna, é elucidar a fisiopatologia da Psoríase, compilar os sinais clínicos característicos da manifestação ungueal e citar métodos de diagnóstico e de avaliação da mesma. O objetivo específico deste estudo é propor uma abordagem podológica para portadores de Psoríase ungueal. Este estudo caracterizou-se como uma revisão de literatura. Foram realizadas buscas sistemáticas no período entre Junho e setembro de 2016, utilizando bancos de dados eletrônicos como: Medline, Science Direct, Directory of Open Access Journals (DOAJ), Scientific Eletronic Library Online (SciELO).

Effect of Methotrexate in the Treatment of Distal Interphalangeal Joint Extensor Tendon Enthesopathy in Patients with Nail Psoriasis.

To assess the effect of methotrexate on the development of distal interphalangeal joint extensor tendon enthesopathy in psoriasis, thirty-two people aged 34 to 57 years with nail psoriasis and distal interphalangeal joint extensor tendon enthesopathy (19 patients with Ps (psoriasis) and 13 with PsA (psoriatic arthritis) were started on methotrexate at 15 to 25 mg/week and the treatment was continued for 6 months). A total of 319 nails were examined. After six months of treatment, the thicknesses of the nail plate, nail bed and nail matrix were found to decrease in both groups of patients. Methotrexate treatment resulted in a decrease in the joint extensor tendon thickness only in patients with Ps (0.94 ± 0.05 vs. 0.96 ± 0.04, p < 0.001), where the tendon thickness after treatment correlated with the matrix thickness (r = 0.337, p = 0.018) and with the bed thickness (r = 0.299, p = 0.039). Methotrexate treatment resulted in a decrease in the extensor tendon thickness only in patients with Ps but not in PsA. The findings of this study may suggest the effectiveness of systemic treatment of nail psoriasis in patients without arthritis and the use of US nail examinations in Ps and PsA patients in morphological change assessment and response to treatment.

Prevalence of onychomycosis among patients with nail psoriasis who are not receiving immunosuppressive agents: Results of a pilot study.

Nail psoriasis and onychomycosis can often be hard to differentiate clinically and may coexist, complicating each other's course. The aim of this study was to determine the prevalence of onychomycosis among patients with nail psoriasis not being treated with immunosuppressive agents, which constitute an independent risk factor for fungal infections. A cross-sectional study was performed. All adult patients with nail psoriasis who were not receiving antifungal and/or immunosuppressive treatment were recruited at the 2nd University Dermatology Department of Aristotle University of Thessaloniki from 10/2016 till 02/2017. If onychomycosis was clinically suspected, nail samples were collected and direct microscopy with 15% KOH solution and culture were performed. Target-NAPSI and DLQI score were also calculated. Of the 23 patients recruited, 20 were men and 3 were women, with a mean age of 53.43years (48.25, 58.62), a mean target-NAPSI score of 10.72 (9.62, 11.77) and a mean DLQI score of 10.17 (7.46, 12.89). A total of 34.78% of patients tested positive for onychomycosis. Yeast were isolated in 37.50% of cases, non-dermatophyte filamentous fungi in 37.50% and T.rubrum in 12.50%. The prevalence of onychomycosis among nail psoriasis patients is higher than that among the general population of Greece (15%-20%). Yeast and moulds predominate in infection cases of nail psoriasis patients.

Effectiveness of adalimumab in the treatment of scalp and nail affection in patients with moderate to severe plaque psoriasis in routine clinical practice.

Data on the effectiveness of biologics in the treatment of nail and scalp psoriasis (PSO) in a routine clinical setting are scarce. The aim of this study was therefore to evaluate the effectiveness of adalimumab in the treatment of nail and scalp psoriatic lesions in routine dermatologic practice. Five hundred one patients were analyzed in this observational study; 157 patients had nail involvement (nail PSO set; NPS) and 404 had scalp involvement (scalp PSO set; SPS). Patients treated with adalimumab were observed for up to 12 months. Outcomes were evaluated via changes in the Nail Psoriasis Severity Index (NAPSI), Psoriasis Scalp Severity Index (PSSI), Psoriasis Area and Severity Index (PASI), and QoL (using the Dermatology Life Quality Index). Eighty-four percent of the patients in the NPS and 93.8% in the SPS achieved a good clinical response upon treatment with adalimumab. Complete clearing of local symptoms was achieved by 33.3% of the patients with nail involvement and 66.7% of the patients with scalp involvement. There was also a marked improvement in QoL. Adalimumab appears to be an effective treatment for scalp and nail PSO in patients with moderate to severe plaque PSO. No new clinical concerns were established.