Pustular psoriasis of the nails: treatment and long-term follow-up of 46 patients

Background Pustular psoriasis of the nail apparatus is a common disease tha t greatly influences the quality of life because of its chronic course and poor response to treatment. Objectives To review the clinical and histopathological features, the respo nse to treatment and the long-term follow-up of 46 patients with pustular p soriasis of the nail unit. Methods Treatments utilized included oral retinoids (n = 12), oral nimesuli de (n = 13), topical calcipotriol (n = 15) and topical steroids (n = 18). R etinoids were utilized as first choice in seven patients with involvement o f several digits and in five patients with severe relapses, whereas topical calcipotriol, oral nimesulide or topical steroids were utilized in patient s with involvement of a single nail. Topical calcipotriol was also prescrib ed as maintenance therapy in patients who responded to oral treatment. Twen ty-five patients were followed for more than 5 years. Results Improvement or regression of the lesions was obtained in 23 of 46 p atients. Retinoids were effective in six of 12 patients, nimesulide in four of 13, topical calcipotriol in nine of 15 and topical steroids in four of 18. The long-term follow-up showed a complete remission of the disease in o nly two patients, both affected by pustular psoriasis involving multiple na ils. All other patients experienced periodic relapses which were in most ca ses controlled by regular use of topical calcipotriol. Conclusions Severe cases of pustular psoriasis of the nail are best treated with systemic retinoids. Topical calcipotriol is effective in about 50% of patients with localized disorder and is also useful as maintenance therapy after retinoid treatment.