Evaluation of the efficacy of acitretin therapy for nail psoriasis.

OBJECTIVE To evaluate the therapeutic efficacy of acitretin in patients with isolated nail psoriasis. DESIGN Open study involving 36 patients with moderate to severe nail psoriasis treated with acitretin. SETTING University-based outpatient dermatology clinic specializing in nail diseases. PATIENTS A total of 27 men and 9 women (mean age, 41 years) with nail psoriasis. INTERVENTION Therapy consisted of acitretin, 0.2 to 0.3 mg/kg/d, for 6 months. MAIN OUTCOME MEASURES Clinical evaluation, and Nail Psoriasis Severity Index (NAPSI) and modified NAPSI scores before therapy, every 2 months during therapy, and 6 months after treatment. RESULTS The mean percentage of reduction of the NAPSI score after treatment was 41%; the mean percentage of reduction of the modified NAPSI score of the target nail was 50%. Clinical evaluation at 6 months showed complete or almost complete clearing of the nail lesions in 9 patients (25%), moderate improvement in 9 (25%), mild improvement in 12 (33%), and no improvement in 6 (11%). CONCLUSION Results from low-dose acitretin therapy show NAPSI score reductions comparable with those studies evaluating biologic drugs for nail psoriasis and suggest that low-dose systemic acitretin should be considered in the treatment of nail psoriasis.