Nail involvement indeed is a frequent event in the course of psoriasis and it causes serious distress. A survey from our clinic about disability associated with nail psoriasis showed that 93 of 1728 patients consider it a major problem; in 58 it interferes with their daily activities; and 52 of patients describe pain as a symptom. Alefacept in the treatment of psoriatic nail disease: a proof of concept study. Nail psoriasis can be debilitating and as therapeutic options are limited, it can be notoriously difficult to treat. We present the results of a prospective, open-label, proof of concept study to determine the efficacy and safety of alefacept in subjects with moderate to severe nail psoriasis. Nail psoriasis is also associated with higher disease severity 3, 6. Psoriatic changes of the nail unit can also be triggered by minor traumas such as manicure, biting the nails, picking or trimming the cuticle, clearing subungual debris, or wearing tight-fitting shoes. There are a few studies with small number of patients in the literature, evaluating the efficacy of alefacept in nail psoriasis.
The most common type, chronic plaque psoriasis, shows well demarked plaques covered by silver scales which are often located symmetrically and bilaterally. Alefacept treatment of psoriatic nail disease: how severe should nail psoriasis be? Nail psoriasis is common in psoriatic patients, particularly in patients with joint involvement. The anatomical location of nail disease can affect the response to topical treatments. Alefacept in the treatment of psoriatic nail disease: a proof of concept study.
Psoriasis is a common papulosquamous skin disease that may be associated with a seronegative spondyloarthropathy. Psoriatic skin lesions are the result of inflammation in the dermis and hyperproliferation with abnormal differentiation of the epidermis. S Food and Drug Administration (FDA) has recently approved a novel therapy for psoriasis targeting Il-12 and IL-23, which will be discussed in the therapy section. The severity of skin and nail involvement does not correlate with the severity of joint disease in patients with PsA. The Nail Psoriasis Severity Index (NAPSI) is a numeric, reproducible, objective, simple tool for evaluation of nail psoriasis. Treatment options for moderate to severe psoriasis include topical and systemic medications, phototherapy, and excimer laser, Combination therapies are often more effective than one treatment alone. Nail psoriasis is linked to psoriatic arthritis.
The Safety And Efficacy Of Alefacept In The Treatment Of Chronic Plaque Psoriasis
Patients will experience a decreased quality of life as a consequence of pain, functional impairment, cosmetic implications of skin and nail lesions, and (in some cases) because of side effects to medication. Adalimumab is licensed for use in adults with severe psoriasis and PsA in whom conventional therapies have failed or are not tolerated. Ustekinumab has proven efficacy in treating psoriatic nail disease 80 and for the treatment of enthesitis 76, 77. Alefacept showed sustained treatment benefit for a drug-free follow-up period of 12 weeks in patients with psoriasis (suggesting the possibility of intermittent treatment regimens), and itolizumab was associated with very prolonged drug-free remission (up to 5 years) 97. The management of nail psoriasis is reviewed in detail separately. Patients with less acute disease can be treated with acitretin or methotrexate as first-line agents. Biological therapies of proven benefit in severe psoriasis include etanercept, adalimumab and infliximab, which target tumour necrosis factor. This results, for example, in the increased loss of water through the epidermis and makes psoriatic skin more susceptible to physical and chemical irritation, contributing to itching and irritation. Patients want a safe, convenient therapy that will rapidly clear their disease and keep it in remission. Alefacept binds to the CD2 receptor on lymphocytes. Psoriatic nails are one of the most difficult management problems faced by dermatologists. Although topical agents and phototherapy are effective for plaque-type lesions of psoriasis, nail disease is usually less responsive to these modalities. Although injections into the lateral nail folds are painful, the pain can be reduced by using small needles, injecting the solution slowly, and using anesthetic spray or ice prior to each injection. Therapeutic effects of a 12-week course of alefacept on nail psoriasis. Medical and scientific articles about Psoriasis, written by M Pasch. Treatment of Nail Psoriasis: Common Concepts and New Trends., A significant association exists between the severity of nail and skin involvement in psoriasis, Journal of the American Academy of Dermatology, vol.
In general, severe or widespread psoriasis is harder to treat. Alefacept (Amevive). Importantly, 70-80 of patients with psoriatic arthritis have nail psoriasis.