Pediatric nail psoriasis is a rarely studied condition. The prevalence of nail alterations in pediatric patients with psoriasis ranges from 17% to 39.2%. The most frequent features of psoriatic nail involvement in children are nail pitting, onycholysis associated with subungual hyperkeratosis, paronychia and pachyonychia. Its management is critical due to the qualityoflife impact, from potential functional impairment issues to the obvious cosmetic problems, which can exacerbate the psychologic distress and social embarrassment of patients with psoriasis. 

A recent report summarized the limited existing data on the successful management of nail psoriasis in the pediatric population.

The main limitation of local treatments is their impaired penetration into the affected area (nails), which can be enhanced by using potent keratolytic topical preparations to reduce the nail volume and facilitate drug absorption.

Besides an infrequent use of systemic treatments in children, methotrexate has been shown to improve psoriatic nail dystrophy in pediatric patients.

The use of acitretin has also been linked with partial improvement of acrodermatitis continua of Hallopeau (ACH)-associated onychodystrophy. 

Biologics are now being widely used in pediatric psoriasis, which has shown success in managing nail psoriasis in children and adolescents. The literature describes the use of secukinumab 150 mg subcutaneously every 4 weeks, Infliximab, a combination of infliximab and methotrexate (infliximab 5 mg/kg intravenously on weeks 0, 2 and 6, and every 8 weeks thereafter; methotrexate 10 mg/wk), adalimumab (initially 80 mg, followed by 40 mg after 1 week and then 40 mg every other week).

It has shown satisfactory outcomes in the treatment of psoriatic onychodystrophy. It includes thalidomide combined with ultraviolet B (UVB) phototherapy. The literature describes the beneficial effects of using combined broadband UVB and thalidomide (50 mg⁄d) treatment, narro-wband UVB (311 nm).

Source: Plachouri KM, Mulita F, Georgiou S. Management of pediatric nail psoriasis. Cutis. 2021;108(5):292-4.