Diagnosis and therapeutic management of nail psoriasis

Abstract

Aim: To identify the comorbidities associated with nail psoriasis and its therapeutic management. Material and methods: A 4-year retrospective analytical study which included 527 patients admitted to the Dermatology Department of the Iasi “Sf. Spiridon” County Clinical Emergency Hospital from Iași. Results: The frequency of cases without nail or arthropathic psoriasis was much higher (88.89% of cases) compared to 32.97% of cases associating arthropathic and nail psoriasis (χ2 = 37.93, p <0.00001). Cases with nail psoriasis were significantly more commonly associated with severe forms of psoriasis with PASI scores higher than 20 (49.57% cases compared to 28.89%, Z = 3.69, p = 0.0001, and to 35.6 %, Z = 2.42, p = 0.008) and similarly, with DLQI scores higher than 20 (52.73% compared to 28.88%, Z = 4.41, p <0.00001 and to 32.54%, Z = 3.79, p = 0.00008). In patients with nail psoriasis, the highest frequency of cases with favorable outcome was obtained with biological treatment (80.85% compared to 39.86% of those with topical treatment, Z = 4.85, p <0.00001 and compared to 43.33% of those with topical and systemic immunosuppressive therapy, Z = 3.93, p = 0.00004). Conclusions: The presence of arthropathic psoriasis may be a risk factor for nail psoriasis, and its absence may be a protective factor against nail psoriasis. Severe forms may lead to quality of life (QOL) impairment with unfavorable, stationary and undulating course. Although nail psoriasis is usually investigated by clinical examination, the diagnosis of incipient form of disease is needed