Psoriatic Nail Disease — SCE Dermatology MCQ

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HardNail DisordersPsoriatic Nail DiseaseSCE Dermatology

A 55-year-old man with chronic plaque psoriasis has nail involvement predominantly affecting the nail matrix (multiple pits, ridging, and crumbling). Which biologic class has shown the highest efficacy specifically for psoriatic nail disease?

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Correct answer: C — IL-17 inhibitors (particularly Ixekizumab)

IL-17 inhibitors, particularly Ixekizumab, have demonstrated the highest NAPSI (Nail Psoriasis Severity Index) improvement rates in clinical trials for psoriatic nail disease. The UNCOVER and IXORA trials showed NAPSI 100 (complete nail clearance) rates of approximately 50% at 60 weeks with Ixekizumab. Other IL-17 inhibitors (Secukinumab, Bimekizumab) also show high nail efficacy. Anti-TNF agents are effective but with lower complete clearance rates. IL-23 inhibitors show good nail responses. Nail psoriasis responds more slowly than skin disease to biologics (6-12 months for full response due to slow nail growth rate). This is an important consideration when choosing biologics for patients with predominant nail disease.

Reference: BAD 2020 Psoriasis Guidelines; IXORA Nail Data; BJD