Nailing Down Nail Psoriasis: Understanding it and Treating it

Today on Inside GRAPPA, host Sebastian Herrera is joined by Lourdes Perez Chada, an Instructor in Dermatology at Harvard Medical School and a clinical investigator at the Brigham and Women’s Hospital in Boston, and Cheryl Rosen who is the Head of the Division of Dermatology,Toronto Western Hospital and University Health Network Hospitals, a Clinician Investigator at Toronto Western Hospital, and a Professor of the Dept of Medicine, University of Toronto.

In this episode, we discuss the importance of nail psoriasis, including the prevalence, manifestations, and diagnosis, and how it affects patients in their daily lives.

Key Topics:

• Prevalence and Diagnosis: Nail psoriasis affects about 50% of patients with psoriasis and up to 90% over their lifetime. The experts discuss clinical diagnostic methods and the challenges in identifying the condition. Tools like biopsies and imaging are rarely used due to their invasiveness.
• Differential Diagnosis: They examine common conditions that can be mistaken for nail psoriasis, including onychomycosis (fungal infections), lichen planus, and alopecia areata.
• Impact on Quality of Life: Nail psoriasis has a significant impact, especially in terms of physical pain, mental health, and daily activities. Patients may experience anxiety and depression, particularly when their hands or feet are affected.
• Association with Psoriatic Arthritis: Nail psoriasis is a risk factor for developing psoriatic arthritis, due to the anatomical connection between the nail and underlying bones. The discussion covers how this link affects prognosis and treatment.
• Treatment Options: Historically difficult to treat, nail psoriasis management ranges from doing nothing for mild cases to topical treatments and biologics. The experts focus on biologics like Ixekizumab and Tofacitinib (Xeljanz), which have shown promise in treating both nail disease and psoriatic arthritis.

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