Abstract
Introduction: Psoriasis is a common chronic autoimmune inflammatory multisystem disease mainly involving skin, nails and joints. Several studies have reported lower levels of vitamin D and calcium in psoriasis. But there is paucity of literature regarding levels of vitamin D and calcium in nail psoriasis. Objective: To study the level of Vitamin D and calcium in psoriasis patients with nail involvement and to correlate their levels with nail severity using Nail Psoriasis Severity Index (NAPSI). Materials and Methods: A total of 60 psoriasis patients with nail changes were recruited for the study. The severity of nail changes was calculated using Nail Psoriasis Severity Index (NAPSI). All non-specific nail changes which were present in the psoriasis patients were noted as well. Apart from routine investigations, blood calcium level and serum vitamin D levels were also sent for investigation. Results: Majority of the participants were male with male: female ratio of 2.75:1. The mean age at of onset of nail involvement was 42.87 17.19 years. About three-fourth of the patients were hypocalcaemic and vitamin D deficient or insufficient. There was a moderate negative correlation between NAPSI and blood calcium (mg/dL), and it was statistically significant (rho = -0.33, P = 0.011). There was a weak positive correlation between NAPSI and S. Vitamin-D (ng/mL), and this correlation was not statistically significant (rho = 0.11, P = 0.402). However, on multivariate regression analysis of NAPSI, significant association was found between nail psoriasis severity index (NAPSI) with blood calcium level and serum vitamin D levels (P=0.01). Conclusion: Blood calcium and serum vitamin D levels were found low in patients of nail psoriasis. Hence, oral vitamin D and calcium supplementation may aid in the earlier response to standard nail psoriasis treatment and further studies are required to prove the therapeutic effect of calcium and vitamin D in nail psoriasis. Keywords: Calcium, V
Highlights
Psoriasis is a common chronic autoimmune inflammatory multisystem disease mainly involving skin, nails and joints
This cross-sectional study was conducted in 60 psoriasis patients with nail changes who were aged more than 18 years attending the outpatient department of dermatology
The severity of nail changes was calculated using Nail Psoriasis Severity Index (NAPSI) where each nail is divided into 4 quadrants and scoring is done on the basis of presence of nail bed or nail matrix signs in each quadrant of the nail
Summary
Psoriasis is a common chronic autoimmune inflammatory multisystem disease mainly involving skin, nails and joints. Objective: To study the level of Vitamin D and calcium in psoriasis patients with nail involvement and to correlate their levels with nail severity using Nail Psoriasis Severity Index (NAPSI). Materials and Methods: A total of 60 psoriasis patients with nail changes were recruited for the study. There was a moderate negative correlation between NAPSI and blood calcium (mg/dL), and it was statistically significant (rho = -0.33, P = 0.011). On multivariate regression analysis of NAPSI, significant association was found between nail psoriasis severity index (NAPSI) with blood calcium level and serum vitamin D levels (P=0.01). Conclusion: Blood calcium and serum vitamin D levels were found low in patients of nail psoriasis. Vitamin D acts by triggering Toll- like receptors on macrophages leading to induction of antimicrobial peptide cathelicidin Vitamin D inhibits production of inflammatory cytokines by monocytes and inhibits dendritic cells differentiation and maturation. In innate immunity, vitamin D acts by triggering Toll- like receptors on macrophages leading to induction of antimicrobial peptide cathelicidin
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