Recommendations for the treatment of nail psoriasis in patients with moderate to severe psoriasis: a dermatology expert group consensus

Background Nail involvement is common in psoriasis patients and is often associated with severe disease. Patients with nail psoriasis experience pain, functional impairment and social stigma, with significant restriction of daily activities and quality of life. However, nail psoriasis often goes untreated, as many physicians believe it is difficult to treat, despite the availability of effective treatment options. Clinical data and guidelines for managing and treating psoriasis patients with both skin and nail symptoms are limited. Objective To prepare recommendations for the management and treatment of patients with moderate to severe psoriasis with nail involvement. Methods A collaborative Delphi survey was used to obtain consensus on current practice in the management of nail disease in patients with moderate to severe psoriasis from an expert panel of 11 dermatologists from Europe and Canada with substantial clinical expertise in managing these patients. Agreement was defined utilizing a Likert scale of 1-9. Consensus regarding agreement was an interquartile range (IQR) >= 7; consensus regarding disagreement was an IQR <= 3. Results The expert panel addressed several topics including burden of disease, nail assessment, treatment goals and treatment options. The panel agreed that: it is extremely important to assess nail involvement in patients with psoriasis; nail assessments are rarely performed in routine clinical practice; full skin and nail clearance is an achievable goal with appropriate systemic therapy in patients with moderate to severe psoriasis with nail involvement. Conclusion This article provides useful and practical considerations for the management and treatment of patients with moderate to severe skin and nail psoriasis. Received: 15 June 2011; Accepted: 27 October 2011