The lifetime incidence of nail involvement in psoriatic patients is estimated to be 80–90%, and the nails can be affected in 10% to 55% of psoriatic patients. Psoriasis may also solely involve the nails, without any other skin findings, in which the treatment can be more challenging. Nail psoriasis may lead to considerable impairment in quality of life due to aesthetic concerns and more importantly limitations in daily activities resulting from the associated pain, which may be overlooked by the physicians. Several topical and systemic treatment modalities, as well as radiation and light systems, have been used in the treatment of nail psoriasis. In the last decade, the introduction of biologic agents and the utilization of laser systems have brought a new insight into the treatment of nail psoriasis. This paper focuses on the recent advances, as well as the conventional methods, in treating nail psoriasis in adults and children, in reference to an extensive literature search. 1. Introduction Psoriasis is a chronic skin disease that causes significant distress and morbidity. Although the skin manifestations are more characteristic, the lifetime incidence of nail involvement in psoriatic patients is estimated to be 80–90%, and the nails can be affected in 10% to 55% of psoriatic patients [1–3]. Moreover, psoriasis may involve the nails only, without any other signs of skin findings [1, 4]. Nail psoriasis has been shown to be associated with longer duration of skin lesions. There is an association between the duration of psoriasis and the severity of nail involvement [2, 3, 5]. Nail psoriasis is also associated with higher disease severity [3, 6]. However, it may also occur in 40% of patients with mild psoriasis [2]. It is slightly more common in male patients than females [3, 6]. Nail psoriasis leads to considerable impairment in quality of life due to aesthetic concerns and more importantly limitations in daily activities resulting from the associated pain [2, 7]. Nail psoriasis may show different clinical presentations according to the structure that is involved within the nail unit. Nail matrix involvement leads to irregular nail pitting (the most common finding of nail psoriasis), dystrophy, and leukonychia; nail bed involvement causes onycholysis, subungual hyperkeratosis, splinter hemorrhages, oil drop patches, and nail thickening, whereas nail fold involvement may result in paronychia [1, 8, 9]. In cases of very severe inflammation, combined nail matrix and nail bed psoriasis may develop, forming “psoriatic crumbly nail.” Psoriatic nail
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