What is Nail Psoriasis?
Nail psoriasis is a chronic autoinflammatory disease characterized by changes in fingernails or toenails of color, surface appearance, thickening, and separation. Involvement of the nail matrix typically causes nail pitting, nail dystrophy, and leukonychia (white discoloration). Involvement of the nail bed typically causes onycholysis (painless detachment of the nail plate from the nail bed), oil drop patches (translucent, yellow-red discoloration), subungual hyperkeratosis, and splinter hemorrhages.
How common is Nail Psoriasis?
Nail psoriasis is estimated to affect up to 50% of the millions of patients with psoriasis and about 80% of patients with psoriatic arthritis. Approximately 1-5% of patients have psoriasis limited to the nails only . Nail psoriasis can have a significant impact on quality of life, causing pain, impaired finger function, and social stigma.
What options are there for patients with Nail Psoriais?
Resources for HS
There are no FDA approved products explicitly approved for the treatment of nail psoriasis. Although some biologics (adalimumab, infliximab, etanercept, ustekinumab) and other systemic therapies (apremilast, acitretin, methotrexate) are effective for nail psoriasis, they are approved for the treatment of moderate-to-severe skin psoriasis and psoriatic arthritis and are typically limited to use for patients with extensive skin or joint involvement. Many of these medication are not covered by insurance unless pateints also have extensive skin or joint involvement. For patients with psoriasis limited to the nails or with low body surface area (BSA) involvement, topical and injectable therapies (corticosteroids, calcipotriol, retinoids, tacrolimus) are preferred due to their favorable safety profile but have limited efficacy. Intralesional corticosteroid injection is used for nail psoriasis but can cause pain on injection, skin atrophy, depigmentation, cyst formation, subungual hemorrhage, tendon rupture, and secondary infection. A topical medication that is effective with a favorable safety profile would fulfill an unmet medical need.
AT-193 for Nail Psoriasis
AT-193 is a topical investigational drug in clinical trials for the treatment of Nail Psoriasis in pateints who do not have enxtenive skin or joint involvment. AT-193 contains a potent AhR agonist in a deeply penetrating formualtion and is made by Azora Therapeutics. AhR agonists have shown efficacy in a number inflammatory diseases but have not be studied clinically in the treatment of HS.
AT-193 is currently being studied in pateints with moderate-to-severe nail psoriais. The study is entitled "A Randomized, Double-Blind, Intrapatient, Placebo-Controlled Multicenter Phase 1b Study Followed by an Open-Label Extension to Evaluate the Safety, Tolerability, and Preliminary Efficacy of Topical AT193 in the Treatment of Patients with Moderate-to-Severe Nail Psoriasis".
If you would like to find out more about the study please go to ClinicalTrials.gov.