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Critical Reviews™ in Therapeutic Drug Carrier Systems
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ISSN Druckformat: 0743-4863
ISSN Online: 2162-660X

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Critical Reviews™ in Therapeutic Drug Carrier Systems

DOI: 10.1615/CritRevTherDrugCarrierSyst.2020029259
pages 135-159

Nail Psoriasis Treatment: Insights into Current Progress and Future Trends

Pradip Nirbhavane
University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Studies, Panjab University, Chandigarh, India
Gajanand Sharma
University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Studies, Panjab University, Chandigarh, India 160 014
Supriya Verma
University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Studies, Panjab University, Chandigarh, India
Rajesh Singh Jadon
School of Studies in Pharmaceutical Sciences, Jiwaji University, Gwalior, India
Bhupinder Singh
University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Studies, Panjab University, Chandigarh, India 160014; UGC-Centre of Excellence in Applications of Nanomaterials, Nanoparticles and Nanocomposites (Biomedical Sciences), Panjab University, Chandigarh, India 160014
Om Parkash Katare
University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Studies, Panjab University, Chandigarh, India


Nail psoriasis is a chronic condition which causes pain and functional impairment; thus, it restricts the activities of daily living and worsens the quality of life. Different chemotherapeutic options are available for treating nail psoriasis such as systemic, intralesional, and topical therapies. However, current chemotherapy suffers from several limitations and to overcome them, new advancements are being made worldwide. Various reports have been published on current progress in the treatment of nail psoriasis such as clinical efficacy studies of novel antipsoriatic agents and novel formulation strategies for current chemotherapy. There are several novel nail formulations for the treatment of nail disorders, particularly onychomycosis, such as vesicular colloidal structure (liposomes, niosomes, transfersomes, ethosomes, etc.) and nonvesicular colloidal structures (nano-emulgel, nanocapsules, thermosensitive gel, etc.) These formulations can also prove beneficial for the treatment of nail psoriasis, and will be heavily explored in the near future. This review provides a brief introduction to the disease, its pathogenesis, and its treatment modalities. The review also throws light onto progress and future perspectives in nail psoriasis treatment.


  1. van de Kerkhof P, Glunther L, Gottlieb AB, Wu JJ, Foley P, Morita A, Goldblum O, Zhang L, Ericson J, Ball S, Rich P. Ixekizumab treatment improves fingernail psoriasis in patients with moderate-to-severe psoriasis: Results from the randomized, controlled and open-label phases of UNCOVER-3. J Eur Acad Dermatol Venereol. 2017;31:477-82.

  2. Langley RG, Krueger GG, Griffiths CE. Psoriasis: Epidemiology, clinical features, and quality of life. Ann Rheum Dise. 2005;64:ii18-23.

  3. Vincent N, Ramya DD, Vedha HB. Progress in psoriasis therapy via novel drug delivery systems. Dermatol Rep. 2014;6:14-28.

  4. Stern RS. Psoriasis. Lancet. 1997;350:349-53.

  5. Van Onselen J. Psoriasis in general practice. Nurs Stand. 1998;12:32-3.

  6. Peters BP, Weissman FG, Gill MA. Pathophysiology and treatment of psoriasis. Am J Health Syst Pharm. 2000;57:645-59.

  7. Ventura A, Mazzeo M, Gaziano R, Galluzo M, Bianchi L, Campione E. New insight into the pathogenesis of nail psoriasis and overview of treatment strategies. Drug Design Develop Ther. 2017;11:2527-35.

  8. Langley RG, Dauden E. Treatment and management of psoriasis with nail involvement: A focus on biologic therapy. Dermatology. 2010;221(Suppl 1):29-42.

  9. Parrish C, Sobera J, Elewski B. Modification of the nail psoriasis severity index. J Am Acad Dermatol. 2005;53(4):745-46.

  10. Kim BR, Yang S, Choi CW, Youn SW. Comparison of NAPSI and N-NAIL for evaluation of fingernail psoriasis in patients with moderate-to-severe plaque psoriasis treated using ustekinumab. J Dermatolog Treat. 2019;30(2):123-28.

  11. Elsayed MMA. Development of topical therapeutics for management of onychomycosis and other nail disorders: A pharmaceutical perspective. J Control Release. 2015;199:132-44.

  12. Gniadecka M, Faurskov Nielsen O, Christensen DH, Wulf HC. Structure of water, proteins, and lipids in intact human skin, hair, and nail. J Invest Dermatol. 1998;110(4):393-8.

  13. De Berker D. Nail anatomy. Clin Dermatol. 2013;31(5):509-15.

  14. Leggit JC. Acute and chronic paronychia. Am Fam Phys. 2017;96(1):44-51.

  15. Walters KA, Flynn GL. Permeability characteristics of the human nail plate. Int J Cosmet Sci. 1983;5(6):231-46.

  16. Murdan S. Drug delivery to the nail following topical application. Int J Pharm. 2002;236:1-26.

  17. Kobayashi Y, Miyamoto M, Sugibayashi K, Morimoto Y. Drug permeation through the three layers of the human nail plate. J Pharm Pharmacol. 1999;51(3):271-78.

  18. Jiaravuthisan M, Sasseville D. Psoriasis of the nail: Anatomy, pathology, clinical presentation, and a review of the literature on therapy. J Am Acad Dermatol. 2007;57(1):1-27.

  19. Sobolewski P, Walecka I, Dopytalska K. Nail involvement in psoriatic arthritis. Rheumatologia. 2017;55:131-5.

  20. Rigopoulos D, Papanagiotou V, Daniel R, Piraccini BM. Onychomycosis in patients with nail psoriasis: a point to point discussion. Mycoses. 2017;60:6-10.

  21. Merola JF, Elewski B, Tatulych S, Lan S. Efficacy of tofacitinib for the treatment of nail psoriasis: Two 52-week, randomized, controlled phase 3 studies in patients with moderate-to-severe plaque psoriasis. J Am Dermatol. 2017;77:79-87.

  22. Rich P, Manhart R. Nail psoriasis. Psoriasis. 2017;2:S7-S13.

  23. Byun SY, Kim BR, Choi JW, Youn SW. Severe nail fold psoriasis extending from nail psoriasis resolved with ustekinumab: Suggestion of a cytokine overflow theory in the nail unit. Ann Dermatol. 2016;28:94-7.

  24. Baraldi A, Jones SW, Guesne S, Traynor MJ, McAuley WJ, Brown MB, Murdan S. Human nail plate modifications induced by onychomycosis: Implications for topical therapy. Pharm Res. 2015;32(5):1626-33.

  25. Gomez C, Anguiano Igea E, Delgado-Charro S, Gomez Amoza JL, Otero Espinar FJ. Microstructural alterations in the onychomycotic and psoriatic nail: Relevance in drug delivery. Eur J Pharm Biopharm. 2018;128:48-56.

  26. Krajewska-Wlodarczyk M, Owczarczyk-Saczonek A, Placek W, Wojtkiewicz M, Wiktorowicz A, Wojtkiewicz J. Ultrasound assessment of changes in nails in psoriasis and psoriatic arthritis. Biomed Res Int. 2018;2018:1-7.

  27. Abignano G, Laws P, Del Galdo F, Marzo-Ortega H, McGonagle D. Three-dimensional nail imaging by optical coherence tomography: A novel biomarker of response to therapy for nail disease in psoriasis and psoriatic arthritis. Clin Exp Dermatol. 2019;44(4):462-65.

  28. Pasch MC. Nail psoriasis: A review of treatment options. Drugs. 2016;76(6):675-705.

  29. Blauvelt A, Armstrong AW, Krueger GG. Essential truths for the care and management of moderate-to-severe psoriasis. J Drugs Dermatol. 2015;14(8):805-12.

  30. Cannavo SP, Guarneri F, Vaccaro M, Borgia F, Guarneri B. Treatment of psoriatic nails with topical cyclosporin: A prospective, randomized placebo-controlled study. Dermatology. 2003;206:153-6.

  31. Tosti A, Ricotti C, Romanelli P, Cameli N, Piraccini BM. Evaluation of the efficacy of acitretin therapy for nail psoriasis. Arch Dermatol. 2009;145(3):269-71.

  32. Gerstein W. Psoriasis and lichen planus of nalis. Treatment with triamcinolone. JAMA Arch Dermatol. 1962;86:819-21.

  33. Saricaoglu H, Oz A, Turan H. Nail psoriasis successfully treated with intralesional methotrexate: Case report. Dermatology. 2011;222:5-7.

  34. Elewski BE, Okun MM, Papp K, Baker CS, Crowley JJ, Guillet G, Sundaram M, Poulin Y, Gu Y, Geng Z, Williams DA, Rich PA. Adalimumab for nail psoriasis: Efficacy and safety from the first 26 weeks of a phase 3, randomized, placebo-controlled trial. J Am Acad Dermatol. 2017;78(1):90-99.

  35. Reich K, Nestle FO, Papp K, Ortonne JP, Evans R, Guzzo C, Li S, Dooley LT, Griffiths CE. Infliximab induction and maintenance therapy for moderate-to-severe psoriasis: A phase III, multicentre, double-blind trial. Lancet. 2005;366:1367-74.

  36. Jung SY. A case of nail psoriasis improved by treatment with golimumab in a psoriatic arthritis patient. Ann Dermatol. 2017;29:491-2.

  37. Garnock-Jones KP. Secukinumab: A review in moderate to severe plaque psoriasis. Am J Clin Dermatol. 2015;16:323-30.

  38. Khattab A, Shalaby S. Optimized ciclopirox-based eudragit RLPO nail lacquer: Effect of endopeptidase enzyme as permeation enhancer on transungual drug delivery and efficiency against onychomycosis. AAPS PharmSciTech. 2018;19(3):1048-60.

  39. Joshi M, Sharma V, Pathak K. Matrix based system of isotretinoin as nail lacquer to enhance transungal delivery across human nail plate. Int J Pharm. 2015;478:268-77.

  40. Kushwaha AS, Repka MA, Narasimha Murthy S. A novel apremilast nail lacquer formulation for the treatment of nail psoriasis. AAPS PharmSciTech. 2017;18(8):1-8.

  41. Nakamura RC, Abreu L, de Duque-Estrada B, Tamler C, Leverone AP. Comparison of nail lacquer clobetasol efficacy at 0,05%, 1% and 8% in nail psoriasis treatment: Prospective, controlled and randomized pilot study. An Bras Dermatol. 2012;87:203-11.

  42. Sanchez Regana M, Marquez Balbas G, Umbert Millet P. Nail psoriasis: A combined treatment with 8% clobetasol nail lacquer and tacalcitol ointment. J Eur Acad Dermatol Venereol. 2008;22:963-9.

  43. Regana MS, Ezquerra GM, Millet PU, Mateos FL. Treatment of nail psoriasis with 8% clobetasol nail lacquer: Positive experience in 10 patients. J Eur Acad Dermatol Venereol. 2005;19(5): 573-7.

  44. Nogueiras-Nieto L, Begona Delgado-Charro M, Otero-Espinar FJ. Thermogelling hydrogels of cyclo-dextrin/poloxamer polypseudorotaxanes as aqueous-based nail lacquers: Application to the delivery of triamcinolone acetonide and ciclopirox olamine. Eur J Pharm Biopharm. 2013;83:370-7.

  45. Gomez EC, Anguiano Igea S, Gomez Amoza JL, Otero Espinar FJ. Evaluation of the promoting effect of soluble cyclodextrins in drug nail penetration. Eur J Pharm Sci. 2018;117:270-8.

  46. Elkeeb R, AliKhan A, Elkeeb L, Hui X, Maibach HI. Transungual drug delivery: Current status. Int J Pharm. 2010;384(1-2):1-8.

  47. Vanstone S, Cordery SF, Stone JM, Gordeev SN, Guy RH. Precise laser poration to control drug delivery into and through human nail. J Control Release. 2017;268:72-7.

  48. Flores FC, Chiu WS, Beck RCR, da Silva CB, Delgado-Charro MB. Enhancement of tioconazole ungual delivery: Combining nanocapsule formulation and nail poration approaches. Int J Pharm. 2018;535(1-2):237-44.

  49. Peruzzo J, Garbin GC, Maldonado G, Cestari TF. Nail psoriasis treated with pulsed dye laser. An Bras Dermatol. 2017;92(6):885-7.

  50. Ashtikar M, Nagarsekar K, Fahr A. Transdermal delivery from liposomal formulations-evolution of the technology over the last three decades. J Control Release. 2016;242:126-40.

  51. Tanriverdi ST, Hilmioglu PS, Yesim MD, Kandiloglu G, Ozer O. Terbinafine hydrochloride loaded liposome film formulation for treatment of onychomycosis: In vitro and in vivo evaluation. J Liposome Res. 2016;26(2):163-73.

  52. Mahtab A, Anwar M, Mallick N, Naz Z, Jain GK, Ahmad FJ. Transungual delivery of keto-conazole nanoemulgel for the effective management of onychomycosis. AAPS PharmSciTech. 2016;17(6):1477-90.

  53. Bseiso E, Nasr M, Sammour O, Abd El Gawad NA. Recent advances in topical formulation carriers of antifungal agents. Indian J Dermatol Venereol Leprol. 2015;81(5):457-63.

  54. Bseiso EA, Nasr M, Sammour OA, Abd El Gawad NA. Novel nail penetration enhancer containing vesicles "nPEVs" for treatment of onychomycosis. Drug Deliv. 2016;23(8):2813-9.

  55. Khan A, Sharma P, Visht S, Malviya R. Niosomes as colloidal drug delivery system: A review. J Chronother Drug Deliv. 2011;2(1):15-21.

  56. Hashim II, El-Magd NF, El-Sheakh AR, Hamed MF, El AE. Pivotal role of acitretin nanovesicular gel for effective treatment of psoriasis: Ex vivo-in vivo evaluation study. Int J Nanomed. 2018;13:1059.

  57. Flores FC, Rosso RS, Cruz L, Beck RC, Silva CB. An innovative polysaccharide nanobased nail formulation for improvement of onychomycosis treatment. Eur J Pharm Sci. 2017;100:56-63.

  58. Wissing SA, Muller RH. The influence of solid lipid nanoparticles on skin hydration and viscoelasticity-in vivo study. Eur J Pharm Biopharm. 2003;56:67-72.

  59. Chen YC, Liu DZ, Liu JJ, Chang TW, Ho HQ, Sheu MT. Development of terbinafine solid lipid nanoparticles as a topical delivery system. Int J Nanomed. 2012;7:4409-18.

  60. Jain A, Garg NK, Jain A, Kesharwani P, Jain AK, Nirbhavane P, Tyagi RK. A synergistic approach of adapalene-loaded nanostructured lipid carriers, and vitamin C co-administration for treating acne. Drug Dev Ind Pharm. 2016;42(6):897-905.

  61. Garg NK, Tyagi RK, Singh B, Sharma G, Nirbhavane P, Kushwah V, Jain S, Katare OP. Nanostructured lipid carrier mediates effective delivery of methotrexate to induce apoptosis of rheumatoid arthritis via NF-kappaB and FOXO1. Int J Pharm. 2016;499:301-20.

  62. Sanna V, Gavini E, Cossu M, Rassu G, Giunchedi P. Solid lipid nanoparticles (SLN) as carriers for the topical delivery of econazole nitrate: In-vitro characterization, ex-vivo and in-vivo studies. J Pharm Pharmacol. 2007;59:1057-64.

  63. Rocha KAD, Krawczyk-Santos AP, Andrade LM, Souza LC, Marreto RN, Gratieri T, Taveira SF. Voriconazole-loaded nanostructured lipid carriers (NLC) for drug delivery in deeper regions of the nail plate. Int J Pharm. 2017;531(1):292-8.

  64. Tripathi P, Kumar A, Jain PK, Patel JR. Carbomer gel bearing methotrexate loaded lipid nanocontainers shows improved topical delivery intended for effective management of psoriasis. Int J Biol Macromol. 2018;120:1322-34.

  65. Elsherif NI, Shamma RN, Abdelbary G. Terbinafine hydrochloride transungual delivery via nanovesicular systems: In vitro characterization and ex vivo evaluation. AAPS PharmSciTech. 2017;18(2):551-62.

  66. Rich P, Gooderham M, Bachelez H, Goncalves J, Day RM, Chen R, Crowley J. Apremilast, an oral phosphodiesterase 4 inhibitor, in patients with difficult-to-treat nail and scalp psoriasis: Results of 2 phase III randomized, controlled trials (ESTEEM 1 and ESTEEM 2). J Am Acad Dermatol. 2016;74:134-42.

  67. Lin YK, See LC, Huang YH, Chang YC, Tsou TC, Lin TY, Lin NL. Efficacy and safety of Indigo naturalis extract in oil (Lindioil) in treating nail psoriasis: A randomized, observer-blind, vehicle-controlled trial. Phytomedicine. 2014;21:1015-20.

  68. Papoutsaki M, Osorio F, Morais P, Torres T, Magina S, Chimenti S, Costanzo A. Infliximab in psoriasis and psoriatic arthritis. BioDrugs. 2013;27(1):13-23.

  69. Dennehy EB, Zhang L, Amato D, Goldblum O, Rich P. Ixekizumab is effective in subjects with moderate to severe plaque psoriasis with significant nail involvement: Results from UNCOVER 3. J Drugs Dermatol. 2016;15:958-61.

  70. Grover C, Daulatabad D, Singal A. Role of nail bed methotrexate injections in isolated nail psoriasis: Conventional drug via an unconventional route. Clin Exp Dermatol. 2017;42:420-3.

  71. Ortonne JP, Paul C, Berardesca E, Marino V, Gallo G, Brault Y, Germain J. A 24-week randomized clinical trial investigating the efficacy and safety of two doses of etanercept in nail psoriasis. Br J Dermatol. 2013;168:1080-7.

  72. Patsatsi A, Kyriakou A, Sotiriadis D. Ustekinumab in nail psoriasis: An open-label, uncontrolled, nonrandomized study. J Dermatolog Treat. 2013;24(2):96-100.

  73. Mease PJ. Psoriatic arthritis: Update on pathophysiology, assessment and management. Ann Rheum Dis. 2011;70(1):i77-84.

  74. Winckle G, Fieldson GT, inventors. Compositions and methods for treating diseases of the nail. United Sates Patent 0175810 A1. 2009 July 9.

  75. Wurdel CM, inventor. Nail lacquer to control scale formation round nail-contg glucocorticoid, cyclosporin and/or calcipotriol. German Patent DE19529085A1. 1997 Feb 13.

  76. Lefrancois MD, De Crieu Navarro RR, inventors; Pierre Fabre Dermo Cosmetique SA, assignee. Tazarotene containing nail polish and its use for the treatment and/or prevention of psoriasis. United States Patent DE60214207T2. 2017 Oct 10.

  77. Espinar FJO, Nieto LN, Felisa Igea FA, inventors; Universidade de Santiago de Compostela, assignee. Aqueous pharmaceutical system for the administration of drugs to the nails. European Patent EP2567710A1. 2013 March 13.

  78. Ying S, Liu JC, Kimbleton E, Wang JCT, inventors; Johnson and Johnson Consumer Companies LLC, assignee. Acidified composition for topical treatment of nail and skin conditions. United States Patent US6231875B1. 2001 May 15.

  79. Dechow FJ, inventor; MQT Holdings LLC, assignee. Organogel formulations for therapeutic applications. United States Patent US20060110342A1. 2006 May 15.

  80. Birnbaum JE, Lerman B, inventors; Hallux Inc., assignee. Method of treating infections, diseases or disorders of nail unit. United States Patent US20140276477A1. 2014 Sept 18.

  81. Jagat S, McKay D, inventors; Nuvo Res Inc., assignee. Topical nail formulation. United States Patent US20090215888A1. 2009 Aug 27.

  82. Nirula A, Nakagawa H, Ohtaki K, Matsudo H, Klekotka P, Kricorian G. Methods of treating nail and scalp psoriasis. WO Application W02015153144A1. 2017 Feb 22.

  83. Mailland F, inventor; Polichem SA, assignee. Use of chitosans for the treatment of nail inflammatory diseases. European Patent EP1958639A1. 2014 Dec 9.

  84. Bohn M, Kraemer KT, inventors. Antipsoriatic nail polish. United States Patent US20040071645A1. 2005 March 24.

  85. Susilo R, inventor. Nail varnish for cosmetic and medical applications. WO Application WO2008049401A2. 2008 May 2.

  86. Dvoretzky I, Kuleza JE, inventor. Therapeutic film forming composition and treatment system therefor. United States Patent US20040071760A1. 2004 April 15.

  87. Lindahl A, Kaufmann P, Wolpert P, inventors. Novel composition for topical use on nail. WO Application WO2012110430A1. 2012 Aug 23.

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