Successful management of treatment resistant nail psoriasis with tildrakizumab

Abstract

Nail psoriasis significantly impacts quality of life and is notoriously difficult to treat. Tildrakizumab, an IL-23 inhibitor, has shown significant clinical improvement in the treatment of moderate-to-severe chronic plaque psoriasis. We report 2 cases of treatment resistant nail psoriasis which showed marked improvement with the use of off-label tildrakizumab. The dosing regimen utilised was consistent with that used to treat chronic plaque psoriasis, with 100 mg subcutaneously at Day 0 and Week 4, and maintenance dosing of 100 mg every 12 weeks thereafter. Significant improvement at 6 and 12 months, as per the modified Nail Psoriasis Severity Index (mNAPSI) and Dermatology Life Quality Ind..