Derm Topics

Diagnosing & Treating Nail Psoriasis in Skin of Color Patients

Next Steps in Derm, in partnership with Skin of Color Update, interviewed Dr. Shari Lipner, director of the Nail Division at the New York-Presbyterian Hospital/Weill Cornell Medical Center. Hear the results of Dr. Lipner’s retrospective study on time to diagnosis in patients with skin of color who have nail psoriasis. Find out why the clinical examination is especially important. Learn how dermoscopy can help with noticing more subtle findings. Plus hear why Dr. Lipner says there is a gap of knowledge about treatment of nail psoriasis in patients with skin of color.


Further Reading

If you want to read more about nail psoriasis, check out the following articles published in the Journal of Drugs in Dermatology:

Nail Psoriasis Improvement During Tildrakizumab Therapy: A Real-Life Experience


The aim of this retrospective study of patients affected by plaque psoriasis who underwent tildrakizumab therapy was to describe and compare the response of the nail psoriasis and the plaque psoriasis elsewhere in the body. Eight patients treated with tildrakizumab, 4 males and 4 females with a mean age of 61 years affected by psoriasis (mean baseline-PASI:13) with nail involvement (mean baseline mNAPSI: 51.9), were followed for at least 20 weeks. At week 4, the mean PASI was 6.6 (49% improvement), and the mean mNAPSI was 30.8 (40.6% improvement). At week 20, the mean PASI was 2.1 (84% improvement), and the mean mNAPSI was 5.1 (90% improvement).

The fast improvement of the nail psoriasis in the 8 patients was unexpected, considering the fact that Tildrakizumab is a molecule that in RCTs (reSURFACE-1 and 2) studies has proved to be efficacious against plaque psoriasis but not strikingly fast, requiring at least 20 weeks to achieve the best PASI-improvements in most patients. Evidence regarding nail improvement during tildrakizumab are scarce. Studies including a higher number of patients are required in order to confirm our observation of the fast improvement of nail psoriasis during Tildrakizumab.

Treatment of Nail Psoriasis


Nail psoriasis has a considerable negative impact on the quality of life by limiting the patient’s household chores, professional activities and social interactions. Treatment for nail psoriasis is often overlooked with treatment for skin and joint involvement being more emphasized. It is also challenging since the clinical improvement takes a long time to be observed and is often met with poor compliance with treatment. This review focuses on the various treatment options for nail psoriasis after review of literature. The literature research considered published journal articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) and reference lists of respective articles. Only articles available in English were considered for this review. 

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