Comment: The quality of evidence is downgraded by study limitations (lack of blinding, selective reporting) and imprecise results (few patients).
A Cochrane review [Abstract] 1 included 18 studies with a total of 1 266 participants comparing various interventions to placebo in individuals with psoriasis with nail involvement. Ten studies assessed topical treatments such as clobetasol, ciclosporin in maize oil, hyaluronic acid with chondroitin sulphates, 5-fluorouracil, a combination of dithranol with salicylic and UVB, tazarotene, and calcipotriol); five studies assessed systemic treatments such as golimumab, infliximab, ustekinumab, ciclosporin, and methotrexate; and three studies assessed radiotherapy such as electron beam, grenz ray, and superficial radiotherapy.
In 5 studies there was significant improvement of nail psoriasis compared to placebo: with infliximab (5 mg/kg), golimumab (50 mg and 100 mg), superficial radiotherapy, electron beam, and grenz rays. This review reported only mild adverse effects, recorded mainly for systemic treatments
| Outcome | Number of participants (trials) | Control:Placebo | Intervention:Infliximab 5 mg | P-value |
|---|---|---|---|---|
| Proportion of individuals with improvement rated by clinician in 6-12 months follow-up | 378(1) | -4%% | 57% | <0.001 |
| Outcome | Number of participants (trials) | Control:Placebo | Intervention:Golimubab 100mg | P-value |
| Proportion of individuals with improvement rated by clinician n 6-12 months follow-up | 405(1) | 0% | 54% | <0.001 |
| Outcome | Number of participants (trials) | Control:Placebo | Intervention:Superficial radiotherapy | P-value |
| Proportion of individuals with improvement rated by clinician in 3-6 nonths follow-up | 46(3) | 0% | 20% | 0.03 |
Systemic therapies are usually not used for treating nails alone; they are used for cutaneous psoriasis or psoriatic arthritis. They can be used if the nail psoriasis is severe, refractory to other treatments, and has a major impact on the person's quality of life. Radiotherapy is not used for psoriasis in common practice.
Date of latest search: 22.03.2012
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