Clinical parameters associated with severity of nail psoriasis and therapeutic efficacy.

Abstract

Nail involvement is common in psoriasis patients, however, there are few detailed studies of clinical parameters related to disease severity and therapeutic efficacy. Our retrospective study aimed to describe the prevalence and clinical characteristics in nail psoriasis patients and determine possible associations between multiple clinical parameters and disease severity or therapeutic efficacy. A total of 89 nail psoriasis patients were included and investigated using dermoscopy. The Nail Psoriasis Severity Index (NAPSI) and the Nijmegen-Nail Psoriasis Activity Index tool (N-NAIL) were used to measure the severity and improvement of nail psoriasis. Severity and efficacy-related parameters were also analysed. Subungual hyperkeratosis (94.4%) was the most commonly observed nail feature. Coexistence of pitting and leukonychia, transverse grooves and thickening were more commonly observed in juveniles than adults. Patients with more severe nail psoriasis were more likely to have more nails affected and develop discolouration. The efficacy of treatment after fixed intervals of treatment was analysed. Most clinical parameters were not related to therapeutic efficacy, including disease duration, age at onset and number of nail signs. However, after six months of treatment, the presence of transverse grooves was shown to be associated with better efficacy. Based on comparison of NAPSI and N-NAIL scores relative to the first visit, the presence of transverse grooves, longitudinal ridges or discolouration were associated with better efficacy. Clinicians should be aware of the clinical parameters related to severity and the use of therapeutic efficacy in choosing individualized treatment and predicting prognosis.