Enhancing Cosmetic and Functional Improvement of Recalcitrant Nail Lichen Planus With Resin Nail.

Lichen planus (LP) is one of the few conditions that may cause permanent and debilitating nail loss. Recurrence is common despite treatment with first-line therapies including intralesional and systemic corticosteroids. We describe application of a resin nail for recalcitrant LP of the fingernail for improved cosmesis and functionality.

Efficacy and Safety of Nail Psoriasis Targeted Therapies: A Systematic Review.

INTRODUCTION: Nail changes are frequent clinical findings in patients with cutaneous psoriasis and psoriatic arthritis, often causing significant impairments in quality of life. Numerous targeted therapies have been previously studied for treatment of nail psoriasis, however, newer agents have not been captured in prior systematic reviews. With over 25 new studies published since 2020, the landscape of nail psoriasis systemic treatments is rapidly evolving, warranting analysis of recently approved therapies. METHODS: An updated systematic review of all PubMed and OVID database studies assessing efficacy and safety of targeted therapies for nail psoriasis was performed, with the goal of incorporating clinical data of recent trials and newer agents, namely brodalumab, risankizumab, and tildrakizumab. Eligibility criteria included clinical human studies reporting at least one of the nail psoriasis clinical appearance outcomes (Nail Psoriasis Severity Index, modified Nail Psoriasis Severity Index). RESULTS: A total of 68 studies on 15 nail psoriasis targeted therapeutic agents were included. Biological agents and small molecule inhibitors included TNF-alpha inhibitors (adalimumab, infliximab, etanercept, certolizumab, golimumab), IL-17 inhibitors (ixekizumab, brodalumab, secukinumab), IL-12/23 inhibitors (ustekinumab), IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab), PDE-4 inhibitors (apremilast), and JAK inhibitors (tofacitinib). These agents all demonstrated statistically significant improvements in nail outcome scores, compared with placebo or with baseline values, at weeks 10-16 and weeks 20-26, with some studies assessing efficacy up to week 60. Safety data for these agents were acceptable and consistent with known safety profiles within these timepoints, with nasopharyngitis, upper respiratory tract infections, injection site reactions, headache, and diarrhea being the most reported adverse events. Specifically, the newer agents, brodalumab, risankizumab, and tildrakizumab, showed promising outcomes for treatment of nail psoriasis on the basis of current data. CONCLUSION: Numerous targeted therapies have shown significant efficacy in improving nail findings in patients with psoriasis and psoriatic arthritis. Data from head-to-head trials have shown greater efficacy of ixekizumab over adalimumab and ustekinumab, as well as brodalumab over ustekinumab, while prior meta-analyses have demonstrated superiority of ixekizumab and tofacitinib to other included agents at various assessed timepoints. Further studies on the long-term efficacy and safety of these agents, as well as randomized controlled trials involving comparison with placebo arms, are needed to fully analyze differences in efficacy of newer agents compared with previously established therapies.

Blue Skin, Nail, and Scleral Pigmentation Associated with Minocycline.

Minocycline, a semisynthetic derivative of tetracycline that is used to treat various infectious and noninfectious conditions, can cause tissue hyperpigmentation. The skin, oral mucosa, sclera, and rarely the nails, can all be affected. The discoloration varies from blue, slate-gray, or brown, and it typically occurs in a dose-dependent fashion. The mechanism of hyperpigmentation, however, remains largely unknown. Herein, we present a case of gray-blue hyperpigmentation of the skin, sclera, and nails after long-term treatment with minocycline for acne.

Curbing COVID-19 Vaccine Hesitancy from a Dermatological Standpoint: Analysis of Cutaneous Reactions in the Vaccine Adverse Event Reporting System (VAERS) Database.

OBJECTIVES: Adverse reactions to the COVID-19 vaccines have been of interest since their emergency authorization. Cutaneous manifestations of the vaccines are not well studied. We aimed to characterize cutaneous reactions to the Moderna (mRNA-1273) and the Pfizer-BioNTech (BNT162b2) COVID-19 vaccines on a large, national scale. METHODS: The Vaccine Adverse Event Reporting System was filtered for cutaneous and hair and nail reactions to the COVID-19 vaccines. Patient demographics and past medical histories, vaccine manufacturer and dosing, symptom timing, reaction location, and patient outcomes were extracted from each report. RESULTS: As of December 24, 2021, there were 67,273 cutaneous reactions to all COVID-19 vaccines, with most patients receiving the Moderna (mRNA-1273) or Pfizer-BioNTech (BNT162b2) vaccines. The most common reactions overall were injection-site reaction, urticaria, and papular rash, with injection-site reaction more common after the Moderna (mRNA-1273) vaccine, and all other cutaneous reactions more common after the Pfizer-BioNTech (BNT162b2) vaccine. Patients with past histories of psoriasis, urticaria, and local site reactions to a vaccine were more likely to report these same symptoms after the COVID-19 vaccine. CONCLUSION: Patients should be counseled about these potential dermatologic reactions to the COVID-19 vaccines. Most occur within the first few days after vaccination, and are mild and self-limiting. Patients should therefore be encouraged that it is safe to receive the COVID-19 vaccine from a dermatological perspective.

Racial, Ethnic, and Sex Disparities in Nail Psoriasis Clinical Trials: A Systematic Review.

Introduction: Nail psoriasis (NP) disproportionally affects quality of life in females versus males. Demographics of NP research cohorts are not well characterized. In this systematic review, we characterize the representation of racial/ethnic groups and women in NP randomized clinical trials (RCTs). Methods: A systematic search of MEDLINE was performed; RCTs of NP pharmacologic treatments or cutaneous psoriasis/psoriatic arthritis with the number of NP patients described were included. Results: Overall, 45 RCTs were analyzed, with 91.1% reporting sex, and 67.9% of participants were men. 7/41 (17%) studies reporting sex included ≥45% female participants. Of 45 RCTs, 35.6% reported race and/or ethnicity. Of the 22 studies with ≥1 US-based site, 13 (59%) reported race/ethnicity; 3 out of 23 (13%) studies with <1 US-based site reported these data. Enrollment of nonwhite participants was significantly lower than representation within the US census (13.4% vs. 39.9%; p < 0.001). Treatment type, route of administration, location with ≥1 US-based site, funding, and journal type were significantly associated with race/ethnicity reporting (p < 0.05 all comparisons). Discussion/Conclusion: Reporting of racial/ethnic demographics is lacking in NP RCTs. Women and racial/ethnic minorities remain underrepresented in NP research. There is a need for increased reporting and diversification of NP clinical trial participants.