James Del Rosso, DO, Diego Dasilva, MD, and Graham Litchman, DO, MS: Management of Severe Nail Psoriasis and Early Psoriatic Arthritis

Send us Fan MailJames Del Rosso, DO, Diego Ruiz Dasilva, MD, and Graham Litchman, DO, MS, discuss the clinical efficacy of bimekizumab (Bimzelx) for patients with severe fingernail psoriasis and concomitant psoriatic arthritis (PsA).They highlighted a case of a 56-year-old woman with extensive dystrophic changes across all 10 fingernails and PsA who had been misdiagnosed and treated for years with antifungals and antibiotics without improvement. After initiating bimekizumab, she achieved complete resolution of all nail and joint symptoms within 3 months.In another case, a 63-year-old woman with nail psoriasis and symptomatic PsA experienced near-complete relief of pain, joint stiffness, and loss of hand dexterity within one month of her first dose, with full nail clearance by 3 months. The discussion emphasizes the challenges of diagnosing nail psoriasis, the significant psychosocial burden it imposes, and the potential for accelerated clearance with dual interleukin (IL)-17A and IL-17F inhibition even in the absence of cutaneous psoriatic involvement.Dr. Del Rosso is with JDR Dermatology Research, Las Vegas, Nevada and Touro University Nevada, Henderson, Nevada. Dr. Dasilva is with Forefront Dermatology, Virginia Beach, Virginia and Eastern Virginia Medical School, Norfolk, Virginia. Dr. Litchman is with Vivida Dermatology, Las Vegas, Nevada and Touro University Nevada, Henderson, Nevada.