How to choose my treatment

Abstract

Determining treatment for nail psoriasis is as much an art as science. All patients with nail psoriasis benefit from education about psoriatic nail disease, the timeline for nail improvement, strategies to protect nails from exacerbating factors, and the overall treatment landscape for psoriatic nail disease. Factors such as nail disease severity, impact on quality of life, risk versus benefit ratio, the severity of plaque psoriasis and psoriatic arthritis, and cost should be considered when choosing treatment. In general, topical medications, intralesional, and device- based therapy are early steps on the therapeutic ladder, and systemic medications including biologics are used in moderate to severe psoriatic disease and when the nail psoriasis does not respond to local therapy.