Nail Changes in Psoriatic Patients and their Association with Disease Severity
Iraqi Postgraduate Medical Journal,
2021, Volume 20, Issue 3, Pages 240-247
Nail psoriasis occurs in both adults and children. Nail involvement is associated with significant physical and psychological consequences for a substantial number of patients. The prevalence of nail changes among patients with psoriasis varies between 10 and 55 percent. In most patients, nail involvement follows or is concurrent with onset of cutaneous psoriasis.
To evaluate nail changes in a sample of Iraqi patients with psoriasis and study their association with the disease severity.
PATIENTS AND METHODS:
The study is a clinico-epidemiological observational cross-sectional study. It was conducted at the outpatient clinic at the Center of Dermatology and Venerology/ Medical City Teaching Hospital between May 2018 and August 2019. A total of 94 patients were enrolled in this study. The severity of psoriasis was assessed using Psoriasis Activity Score Index (PASI), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI) scores whereas the severity of nail involvement was assessed by Nijmegen Nail Psoriasis Activity Index Tool (N-NAIL) and then compared against psoriasis scores. The patients were divided into two groups; patients with (group A) and without (group B) nail involvement.
The study sample included 41 males (43.62%) and 53 females (56.38%). The mean age at presentation was 32.59±16.32 years. The number of patients in group A was 69 patients (73.4%). The mean ±SD for PASI score was 6.6±7.71 and the mean ±SD for DLQI score was 11.36 ±7.93.While the number of patients in group B was 25 patients (26.6%). The mean ±SD for PASI score was 4.38±3.02 and the mean ± SD for DLQI score was 8.48±4.77.There were no statistical differences between group A and group B regarding age, duration of the disease, PASI score and DLQI score. The patients in group A were subdivided into two groups: the first group included patients with mild psoriasis; 37 patients (PASI score ≤ 10) and the second group included patients with moderate to severe psoriasis; 10 patients (PASI score > 10).The patients with severe cutaneous psoriasis had more severe nail changes. In patients with mild psoriasis, the N-NAIL score was 25.62±23.96 while in patients with moderate to severe psoriasis, the N-NAIL score was 48.8±27.95 (p value =0.011). Crumbling, onycholysis and subungual hyperkeratosis were more frequent in this group. In general, pitting was the most frequently observed finding (52.13%) followed by onycholysis and crumbling.
This is the first study of nail changes in psoriasis patients in Iraq. Nail changes were observed in 73.4% of patients with pitting as the most frequent nail finding. The patients with severe psoriasis had more severe nail changes with higher N-NAIL scores than patients with mild psoriasis.
- Peter C. M. van de Kerkhof and Frank O. Nestlé. Psoriasis. In: Bolognia JL, Schaffer JV, Cerroni LL eds Dermatology. 4th ed. London: Elsevier Limited; 2018: 138–60.
- Oram Y, Akkaya AD. Treatment of Nail Psoriasis: Common Concepts and New Trends. Dermatol Res Pract. 2013;2013:1–13.
- Sharada RG and Thomas J. A Study on Psoriasis of Nails- Severity Scoring System. ARC J Dermatol. 2016 ;1:13-6.
- Choi JW, Kim BR, Seo E, Youn SW. Identification of nail features associated with psoriasis severity. J Dermatol. 2017; 44:147–53.
- Marina EM, Botar-Jid C, Bolboaca SD, Roman II, Senila CS, Mihu CM, et al. Patterns of clinical nail appearances in patients with cutaneous psoriasis. Med Pharm Rep. 2017; 90: 22–7.
- Ahmed I, Nasreen S. Frequency and pattern of nail changes in patients with psoriasis vulgaris. J Pak Assoc of Dermat. 2009;19:194–9.
- Oakley A. PASI score. DermaNet NZ. Available at: https://dermnetnz.org/topics/pasi-score. Accessed at January 6, 2020
- Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)-a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994; 19: 210–6.
- Klaassen KMG, van de Kerkhof PCM, Bastiaens MT, Plusjé LGJM, Baran RL, Pasch MC. Scoring nail psoriasis. J Am Acad Dermatol. 2014; 70: 1061–6.
- Klaassen KMG, van de Kerkhof PCM, Pasch MC. Nail Psoriasis, the unknown burden of disease. J Eur Acad Dermatol Venereol. 2014; 28: 1690–5.
- Augustin M, Reich K, Blome C, Schäfer I, Laass A, Radtke MA. Nail psoriasis in Germany: epidemiology and burden of disease: Nail psoriasis in Germany. Br J Dermatol. 2010;163:580–5.
- Kaur I, Saraswat A, Kumar B. Nail changes in psoriasis: a study of 167 patients. Int J Dermatol. 2001;40:601–3.
- Grover C, Reddy BSN, Uma Chaturvedi K. Diagnosis of nail psoriasis: importance of biopsy and histopathology. Br J Dermatol. 2005;153:1153–8.
- De Luca A, Zelante T, D’Angelo C, Zagarella S, Fallarino F, Spreca A, et al. IL-22 defines a novel immune pathway of antifungal resistance. Mucosal Immunol. 2010;3: 361–73.
- Kisand K, Bøe Wolff AS, Podkrajšek KT, Tserel L, Link M, Kisand KV, et al. Chronic mucocutaneous candidiasis in APECED or thymoma patients correlates with autoimmunity to Th17-associated cytokines. J Exp Med. 2010;207:299–308.
- Kagami S, Rizzo HL, Kurtz SE, Miller LS, Blauvelt A. IL-23 and IL-17A, but Not IL-12 and IL-22, Are Required for Optimal Skin Host Defense against Candida albicans. J Immunol. 2010 Nov 1;185(9):5453–62.
- Taheri Sarvtin M, Shokohi T, Hajheydari Z, Yazdani J, Hedayati MT. Evaluation of candidal colonization and specific humoral responses against Candida albicans in patients with psoriasis. Int J Dermatol. 2014;53:e555–60.
- Fry L, Baker BS. Triggering psoriasis: the role of infections and medications. Clin Dermatol. 2007;25:606–15.
- Goldminz AM, Au SC, Kim N, Gottlieb AB, Lizzul PF. NF-κB: An essential transcription factor in psoriasis. J Dermatol Sci. 2013;69:89–94.
- Rashmi R, Rao KSJ, Basavaraj KH. A comprehensive review of biomarkers in psoriasis. Clin Exp Dermatol. 2009;34:658–63.
- Iyer SS, Cheng G. Role of interleukin 10 transcriptional regulation in inflammation and autoimmune disease. Crit Rev Immunol. 2012;32:23–63.
- Saulite I, Pilmane M, Kisis J. Expression of Antimicrobial Peptides in Nail Psoriasis and Normal Nails. Acta Derm Venereol. 2017;97:644–5.
- McGonagle D, Benjamin M, Tan AL. The pathogenesis of psoriatic arthritis and associated nail disease: not autoimmune after all?: Curr Opin Rheumatol. 2009;21:340–7.
- Gniadecki R. Next-generation antipsoriatic drugs: small molecules join. Br J Dermatol. 2015 ;173:1355–6.
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