ABSTRACT
Nail psoriasis is common in adult psoriatic patients. Although several new drugs have recently been introduced for the treatment of skin psoriasis, treatment of nail psoriasis still remains a challenge. Topical treatments (e.g., corticosteroids, tazarotene, 5-fluorouracil, calcipotriol) are the first line in the management of skin psoriasis. The efficacy of these drugs in nail disease, however, is limited, mainly due to the difficulty in penetrating the nail bed and nail matrix. In cases of nail disease resistant to topical treatment, methotrexate, ciclosporin, acitretin, or biological agents can be used. The present authors introduce a 73-year-old patient affected by impressive psoriatic nail disease involving all her fingernails and toenails treated by acitretin, a traditional systemic treatment. After 2 months of treatment there was a marked improvement. The clinical improvement of the nails was progressive and 6 months later it was stable and satisfactory. The remarkable response to treatment in this case suggests that oral acitretin, in association to urea nail lacquer, might be useful in the management of disabling severe nail psoriasis even in absence of severe cutaneous involvement.
Subject(s)
Acitretin/therapeutic use , Keratolytic Agents/therapeutic use , Nail Diseases/drug therapy , Psoriasis/drug therapy , Acitretin/administration & dosage , Aged , Female , Humans , Keratolytic Agents/administration & dosage , Nails/drug effects , Treatment OutcomeSubject(s)
Acanthoma/diagnosis , Facial Neoplasms/diagnosis , Skin Neoplasms/diagnosis , Acanthoma/pathology , Acanthoma/surgery , Facial Neoplasms/pathology , Facial Neoplasms/surgery , Follicular Cyst/diagnosis , Follicular Cyst/pathology , Humans , Male , Middle Aged , Neoplasms, Basal Cell/diagnosis , Neoplasms, Basal Cell/pathology , Skin Neoplasms/pathology , Skin Neoplasms/surgeryABSTRACT
Background After the expiry of the patent of reference etanercept, several biosimilars have been developed, including SB4. Objective To study safety and efficacy of SB4 in psoriatic patients previously treated with etanercept and in the etanercept naive ones. Method Patients affected by moderate to severe psoriasis and/or psoriatic arthritis attending the Psoriasis Center of Florence University, treated with SB4 were enrolled in the study. Patients were divided in two cohorts. Cohort 1 included 32 patients who were switched from previous etanercept, cohort 2 included 12 patients who were naive to etanercept. Results Evaluation of the efficacy of SB4 in cohort 1 patients revealed rates of clinical remission (defined as both PASI and/or DAS28 increase < 10%) of 92% and 64% for psoriasis and psoriatic arthritis respectively. In cohort 2 at week 24 PASI 75 was observed in 75% of patients. Conclusion In our experience switching from originator to SB4 in psoriatic patients seems not to influence efficacy, especially cutaneous manifestations, over a median observational period of 24 weeks.