Psoriasis treatment in difficult locations: scalp, nails, and intertriginous areas

The 2008 document reviews treatment options for psoriasis in challenging areas such as the scalp, nails, and intertriginous regions. It notes that while topical treatments are first-line, systemic treatments may be needed for severe cases. Scalp psoriasis is commonly treated with keratolytics, corticosteroids, and vitamin D3 analogues, with newer formulations like foams and gels being preferred by patients. Nail psoriasis treatments, including topical corticosteroids and vitamin D analogues, often have limited effectiveness, and systemic treatments show better improvement. Intertriginous psoriasis can be treated with corticosteroids, vitamin D analogues, and calcineurin inhibitors, with calcineurin inhibitors showing potential for future use. A study with 58 patients showed betamethasone dipropionate with salicylic acid and calcipotriol ointment reduced nail thickness by about 50% after 5 months. Another study with 31 patients found tazarotene 0.1% gel significantly reduced onycholysis and pitting after 24 weeks. A multicenter trial with 378 patients showed biologic agents like infliximab improved nail psoriasis severity index at week 50. For intertriginous psoriasis, a pilot study with 20 patients showed fluticasone propionate ointment was effective, and another study with 80 patients confirmed the efficacy of betamethasone valerate, calcipotriol, and pimecrolimus. Despite advancements, treating psoriasis in these areas remains difficult, and systemic treatments for isolated nail psoriasis should be considered on an individual basis.