Low-dose acitretin may help reduce nail psoriasis

Low-dose acitretin (a drug used to treat skin psoriasis) therapy appears to reduce nail psoriasis symptoms, according to a report in the March issue of Archives of Dermatology.

Up to 78 percent of psoriasis patients experience nail psoriasis, which consists of irregular pitting, salmon-colored patches on the nail bed and onycholysis (separation of the nail from the nail bed) with erythematous (reddened and often inflamed) borders on several fingernails or toenails, according to background information in the article. "The quality of life of patients with severe nail psoriasis is affected as a result of pain and poor cosmetic appearance, subsequently leading to restricted activities of daily living," the authors write.

Antonella Tosti, M.D., of University of Bologna, Italy, and colleagues evaluated the effectiveness of low-dose acitretin therapy (0.2 to 0.3 milligrams per kilogram per day for six months) on the nails of 36 patients (27 men and nine women, average age 41 years) who had psoriasis involving only the nails. Researchers used the Nail Psoriasis Severity Index (NAPSI) to grade the severity of the condition. Higher NAPSI scores indicated more severely affected nails. Patients were followed up for at least six months after treatment.

"The mean percentages of reduction of the NAPSI score and modified NAPSI score were 41 percent and 50 percent, respectively," the authors write. "Clinical evaluation at six months showed complete or almost complete clearing of the nail lesions in nine patients (25 percent), moderate improvement in nine (25 percent), mild improvement in 12 (33 percent) and no improvement in six (11 percent)."

"Only one of the 36 patients experienced adverse effects on the nail during treatment," the authors note. All participants whose condition improved did not return to pre-treatment conditions.

"Although more studies are required to thoroughly assess the effectiveness in larger controlled subject populations, our observations suggest that low-dose systemic acitretin should be considered in the therapeutic armamentarium in the treatment of nail psoriasis," the authors conclude.