Biologics and Small Molecules for Inflammatory Nail Disorders: A Narrative Review

The narrative review examines the use of biologics and small molecules for treating inflammatory nail disorders, such as nail psoriasis, nail lichen planus, alopecia areata nail dystrophy, and atopic dermatitis nail dystrophy. It highlights the effectiveness of treatments like IL-17 inhibitors (e.g., ixekizumab) and JAK inhibitors (e.g., tofacitinib) in improving symptoms, with TNF inhibitors (e.g., adalimumab) being FDA-approved for nail psoriasis. The review underscores the need for personalized treatment plans based on efficacy, safety, and patient-specific factors. It also notes the importance of patient education on treatment benefits and risks, considering comorbidities, and the potential of emerging therapies targeting specific pathways. Notably, risankizumab and ustekinumab showed significant efficacy in trials with 964 and 545 patients, respectively, while tofacitinib showed promise in smaller studies for alopecia areata nail dystrophy.