Nail psoriasis: dynamics of the clinical course during anti-IL-17 therapy

Abstract

Psoriasis is a chronic immune-mediated inflammatory disease in which the pathological process quite often involves the nail apparatus. Psoriatic onychodystrophy is considered a serious psychological and social problem, as nail lesions are not only a cosmetic defect, they can also complicate daily activities, including employment, ability to work and generally impair the quality of life of patients. In addition, numerous studies and clinical practice show that nail lesions in psoriasis are also associated with a more severe course of the skin process, and are rather torpid to therapy. Moreover, psoriatic onychodystrophy is considered as a form of enthesitis, which is in fact an important predictor of the development of psoriatic arthritis. Various topical, systemic and physiotherapeutic options have been recommended in the therapy of psoriasis with nail plate damage, but the effectiveness of these therapeutic methods is in most cases insufficient and the search for highly effective treatment is of great clinical importance at present. Taking into consideration the critical importance of interleukin (IL)-17 in the pathogenesis of psoriasis, its inhibitors allow to achieve a stable remission of cutaneous and joint processes, thus, it is promising in the therapy of psoriatic onychodystrophy. The article presents the literature data on epidemiology, clinical picture of nail changes in psoriasis, the review of effective pathogenetic methods of psoriatic onychodystrophy therapy and personal clinical observations of patients with severe psoriasis with nail plate damage treated with Russian interleukin 17A inhibitor – Netakimab. These observations allow to draw a conclusion about high efficacy of netakimab in the therapy of patients with psoriasis including the presence of such hardtop-treat localizations as nail lesions.