PSORIASIS UNGUEAL PDF

Medwave se preocupa por su privacidad y la seguridad de sus datos personales. Apart from involving skin, psoriasis can compromise the nails and adjacent structures. Even though there are multiple therapeutic alternatives, there is great interest in biological therapy, but no consensus on its role exists. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified two systematic reviews including three randomized trials.

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Medwave se preocupa por su privacidad y la seguridad de sus datos personales. Apart from involving skin, psoriasis can compromise the nails and adjacent structures. Even though there are multiple therapeutic alternatives, there is great interest in biological therapy, but no consensus on its role exists. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified two systematic reviews including three randomized trials.

We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded it is not clear whether biological therapy is superior to placebo in the treatment of nail psoriasis because the certainty of the evidence is very low.

Psoriasis is a common disease that can affect skin, joints and nails. It corresponds to an autoimmune disorder mediated by T cells that interact with keratinocytes and other cells of the skin.

The treatment of psoriasis with biologic agents is routinely used in patients with moderate to severe psoriasis or refractory psoriatic arthritis.

Good results in these situations have raised interest in evaluating them in the treatment of nail psoriasis. We used Epistemonikos database, which is maintained by screening more than 30 databases, to identify systematic reviews and their included primary studies. With this information, we generated a structured summary using a pre-established format, which includes key messages, a summary of the body of evidence presented as an evidence matrix in Epistemonikos , meta-analysis of the total of studies, a summary of findings table following the GRADE approach and a table of other considerations for decision-making.

What is the evidence. This table and the overall summary are based on the latter. All studies included adult patients, over 18 years old, of both sexes, with nail psoriasis and no other nail disease. Studies of patients with pustular psoriasis of the nails, acropustulosis keratotica and acrodermatitis continua of Hallopeau were excluded.

It was compared with placebo at week 24 and then a crossing over was done to complete 24 more weeks. One study used subcutaneous ustekinumab 45 mg or 90 mg at weeks 0 and 4 and then every 12 weeks until week 52 [5].

Other outcomes were: adverse effects, quality of life and improvement on nail features pain, thickness, hyperkeratosis, number of affected nails and growth. This table and the summary in general are based on the latter. The information on the effects of biological therapy for nail psoriasis is based on three randomized trials involving patients.

All studies reported the severity of nail psoriasis and adverse effects. Differences between this summary and other sources. Using automated and collaborative means, we compiled all the relevant evidence for the question of interest and we present it as a matrix of evidence. After creating an account in Epistemonikos, users will be able to save the matrixes and to receive automated notifications any time new evidence potentially relevant for the question appears.

Epistemonikos foundation is a non-for-profit organization aiming to bring information closer to health decision-makers with technology. Its main development is Epistemonikos database www. Are biologics useful for nail psoriasis?. Medwave ;16 Suppl 1 :e doi: Ficha PubMed. Contacto English Email: Clave:. Abstract Apart from involving skin, psoriasis can compromise the nails and adjacent structures.

Interventions for nail psoriasis. Cochrane Database Syst Rev. Therapies for psoriatic nail disease. A systematic review. J Rheumatol. Baseline nail disease in patients with moderate to severe psoriasis and response to treatment with infliximab during 1 year. J Am Acad Dermatol. Golimumab, a new human tumor necrosis factor alpha antibody, administered every four weeks as a subcutaneous injection in psoriatic arthritis: Twenty-four-week efficacy and safety results of a randomized, placebo-controlled study.

Arthritis Rheum. J Dermatol. Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: a phase III, multicentre, double-blind trial. Skin and nail responses after 1 year of infliximab therapy in patients with moderate-to-severe psoriasis: a retrospective analysis of the EXPRESS Trial. Infliximab produces a sustained and significant improvement in psoriasis over 50 weeks of continuous therapy Abstract O British journal of dermatology. Nail psoriasis improvement is maintained in patients with moderate to severe psoriasis treated with infliximab Abstract P Significant response of nail psoriasis to infliximab in patients with moderate to severe psoriasis disease.

Remission and time of resolution of nail psoriasis during infliximab therapy. Alefacept in the treatment of psoriatic nail disease: a small case series. British Association of Dermatologists' guidelines for biologic interventions for psoriasis Br J Dermatol.

CrossRef PubMed. Cassell S, Kavanaugh AF. Acceso Webactivo. Medwave Estudios. ISSN Key messages It is not clear whether biological therapy has a role in the treatment of nail psoriasis because the certainty of the evidence is very low. What types of patients were included. What types of interventions were included.

What types of outcomes were measured. To whom this evidence does and does not apply. The evidence presented in this summary is generally applicable to all adult patients with nail psoriasis. Does not apply to patients with other nail diseases or with pustular psoriasis of the nails, acropustulosis keratotica or acrodermatitis continua of Hallopeau.

About the outcomes included in this summary. Nail Psoriasis Severity Index NAPSI measured in the most affected nail was the outcome selected because it was the only outcome measured in all three studies to determine the severity of nail psoriasis, and corresponds to a critical outcome for decision making.

Balance between benefits and risks, and certainty of the evidence. Adverse effects are more common in biological therapies compared to placebo, although these are not serious. What would patients and their doctors think about this intervention. Due to the existence of other effective therapeutic measures in this condition it is likely that most patients would not be inclined to use an intervention of high cost and adverse effects associated with an uncertain benefit.

Resource considerations. The findings of our summary are consistent with those of the systematic reviews identified. The conclusions of this summary are in partial agreement with the British Association of Dermatologists' guideline for biologic interventions for psoriasis [13] , which refers infliximab as an intervention for nail psoriasis. It would also be indicated for patients with joint involvement that have been refractory or have contraindications to standard systemic therapy.

The probability that the main findings of this summary change with future evidence are very high due to the very low certainty of the evidence so far.

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Treatment of nail psoriasis remains a challenging and often disappointing situation.. To compare the efficacy, adverse reactions and tolerability of treatment of nail psoriasis with PDL vs. Nd:YAG, in association with betametasona calcipotriol gel.. An open, prospective intrapatient left-to-right study was designed. Betamethasone calcipotriol gel was applied once a day during the first week after each laser session. A total of four sessions were administered.. All patients showed improvement in nail bed and nail matrix psoriasis.

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