Topical application of fumaric acid esters improves appearance of nail psoriasis

Background: Nail psoriasis usually represents a therapeutic challenge, as it poorly responds to conventional topical treatments, and usually requires systemic conventional or biological drugs to improve. Objectives: To evaluate the efficacy and safety profile of a new topical agent containing 1% fumaric acid esters (FAEs), in cream-gel vehicle, for treatment of nail psoriasis in patients failing to achieve a complete control of fingernail involvement with ongoing treatment for psoriasis for 12 weeks at least. Methods: Seventy-four psoriatic patients with mild to moderate psoriasis in treatment with PUVA, UVB-nb, Methotrexate, Cyclosporine, Acitretin and stable disease for at least 3 months before the enrollment into the study, who had failed to respond for their fingernail involvements were sequentially enrolled into the study. All patients were asked to implement ongoing therapy by applying a cream-gel twice daily for 24 weeks, 37 among them received a cream-gel containing 1% FAEs, the others 37 a placebo gel, free from fumaric acid esters. Disease severity of psoriatic nails was evaluated in both groups through the Modified Nail Psoriasis Severity Index (mNAPSI) calculated both at T0 and T24. The impact of nail involvement on quality of life were also evaluated from the patient point of view through the self-administered Nail Psoriasis Quality of Life 10 Test (NPQ10), both at baseline and at T24. Results: A significant improvement of fingernail psoriasis occurred in most patients receiving the active treatment after 24 weeks, the mean value of mNAPSI moves from the baseline value of 14.89±2.105 (T0) to the post-treatment value of 5.89±1.64 (p<0.001) (T24). Similarly, the quality of life improved as demonstrated by the reduction of NPQ10 from a baseline value of 8.83±1.14 (T0). to the post-treatment value of 3.89 ±1.07 (p<0.001) (T24). Conclusions: Even if further studies on a larger series of patients are needed, our preliminary results seem to indicate that a cream-gel containing 1% FAEs, could be a promising treatment for fingernail psoriasis.