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Challenges in Psoriasis Treatment: Nail, Scalp, and Palmoplantar Involvement

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Advances in Psoriasis

Abstract

Psoriasis can affect many areas of the body and treatments should target the areas of involvement. Nail disease is difficult to treat with topical therapy as the vehicle must be optimized to penetrate the nail and surrounding tissues. Some of the inflammation in nail disease is deep in the nail matrix and thus difficult for topical therapies to access. Scalp disease is difficult to treat with topical and phototherapy due to the presence of hair, bathing habits, and convenience issues. The palms and soles often have particularly thick plaques of psoriasis which may prevent absorption of topical therapy and resist phototherapy. Patients with primarily palmoplantar disease often do not respond to multiple therapies, and many require combination therapy for disease control. Collectively, nail, scalp, and palmoplantar psoriasis are considered “tough to treat” and often do not respond as well as plaque psoriasis elsewhere on the body. This chapter will critically address the challenges posed by each condition and evaluate available treatment options.

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  1. Bakersfield Dermatology and Skin Cancer Medical Group, Bakersfield, CA, USA

    Jeffrey J. Crowley

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    Jeffrey M. Weinberg

  2. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Mark Lebwohl

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Crowley, J.J. (2021). Challenges in Psoriasis Treatment: Nail, Scalp, and Palmoplantar Involvement. In: Weinberg, J.M., Lebwohl, M. (eds) Advances in Psoriasis. Springer, Cham. https://doi.org/10.1007/978-3-030-54859-9_26

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