A cross-sectional observational study of clinical, histopathological, and dermoscopic correlation in patients with nail psoriasis at a tertiary care hospital

Abstract

Background: Among various nail disorders encountered in dermatology outpatient department, nail psoriasis is not uncommon. Around 80%–90% of patients with psoriasis present with nail involvement at some point in their life. In 1%–5% of patients, alterations compatible with nail psoriasis may also occur in the absence of cutaneous lesions. There is limited literature on nail psoriasis especially in Indian patients. Objective: The present study was undertaken to evaluate clinical, histopathological, and dermoscopic features in nail psoriasis and its impact on quality of life. Materials and Methods: All clinically suspected cases of nail psoriasis were included in the study. Clinical parameters and dermoscopic findings were observed and noted. Nail biopsy was performed to confirm the findings. Impact on quality of life was evaluated by correlating Nail Psoriasis Severity Index (NAPSI) score and nail psoriasis quality of life scale (NPQ10) score. Results: Of 50 patients with clinically suspected nail psoriasis, skin involvement was seen in 45 (90%), and 5 (10%) had only nail involvement. The mean NAPSI score was 34.34 in our study. The most common clinical nail finding was pitting (38 [76%]) followed by onycholysis (31 [62%]). The most common dermoscopic finding was pitting (39 [76%]) followed by onycholysis (32 [64%]). Histopathologically, the most common finding was parakeratosis (41 [82%]) followed by focal hypergranulosis (40 [80%]). The majority of the patients (21 [42%]) had NPQ10 (modified) score between 10 and 20, and moderate positive correlation between NAPSI score and NPQ10 scale score was observed. Limitations: Small sample size and no control group. Conclusion: Nail psoriasis does impact the quality of life of patients especially in females who feel embarrassed in social gatherings and workplace. Nail biopsy, though painful and difficult to perform, is the most efficient method to diagnose nail psoriasis.