The major problem when treating nail psoriasis is either the difficulty of the topical medications to present their therapeutic efficacy or the side effects of the systematically administrated drugs. Topical medications must penetrate the nail plate which in normal conditions presents unique barrier properties, taking in consideration also that in psoriasis it can be thickened due to the hyperkeratosis of the nail bed, increasing difficulties in acting properly. Systemic drugs have three major problems. The first has to deal with side effects of these drugs, the second with interactions with other systemic medications that these patients are probably receiving, and the third with the lack of on-label indication for nail psoriasis. The latter is a major problem when the patient has isolated nail involvement.
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