Nail manifestations of psoriasis are detrimental to patient’s quality of life (QoL) and are a prognostic factor for more severe skin disease and comorbidities, such as psoriatic arthritis

First-line treatments for few-nail disease (≤ 3 nails involved) includes topicals and intralesional injections

When disease involves > 3 nails, has extensive cutaneous and joint involvement, and has a significant impact on QoL, systemic therapies should be considered

Certain interleukin (IL)-17 inhibitors have been shown to be superior to IL-12/23 inhibitors (brodalumab vs. ustekinumab) and have superior short-term efficacy in comparison to IL-23 inhibitors (ixekizumab vs. guselkumab) and tumor necrosis factor (TNF)-alpha inhibitors (ixekizumab vs. etanercept), though their long-term efficacy is similar to TNF-alpha inhibitors

Certain TNF-alpha inhibitors have similar efficacy to IL-23 inhibitors (adalimumab vs. guselkumab)