Case study | upadacitinib in a pediatric patient with nail psoriasis

Nail psoriasis is a common manifestation in patients with psoriatic disease, affecting ~80% of individuals with psoriasis.¹  Nail psoriasis can be indicative of more severe disease, and can be predictive of psoriatic arthritis development.¹ Nail psoriasis can also impact quality of life, causing pain and functional impairment.¹ Here, we discuss a case study of a pediatric patient with nail psoriasis who received treatment with upadacitinib.

This is a case study of a 13-year-old patient who has been affected by progressive nail distortion for 8 years.¹ The patient history is given in Figure 1.

Figure 1. Patient history* 

*Data from Wang, et al.¹

The patient also underwent a longitudinal nail biopsy.¹ The biopsy revealed hyperkeratosis, parakeratosis, and neutrophils in the nail plate. There were no infections identified in culture. The patient was screened for small molecule inhibitor treatment, and treatment with upadacitinib was started.¹ Improvements in outcomes after treatment are shown in Figure 2.

Figure 2. Improvements in NAPSI and DLQI after treatment* 

DLQI, Dermatology Life Quality Index; NAPSI, Nail Psoriasis Severity Index; QD, once daily.
*Data from Wang, et al.¹

At Week 20, there was pitting and discolouration on only one finger.¹ The results were maintained up to the 24-week follow-up evaluation. Psoriasis on the toenails also resolved with upadacitinib treatment. There were no adverse events during treatment.¹

Conclusion 

In this case study, treatment with upadacitinib led to improvements in Nail Psoriasis Severity Index and Dermatology Life Quality Index over 24 weeks, with no safety concerns.¹ This suggests that upadacitinib may be an effective treatment option for patients with nail psoriasis; however, clinical trials are warranted. Upadacitinib is currently only approved in psoriatic arthritis for adult patients in the United States² and Europe.³