Psoriatic onychodystrophyorpsoriatic nails is a nail disease. It is common in those with psoriasis, with reported incidences varying from 10% to 78%. Elderly patients and those with psoriatic arthritis are more likely to have psoriatic nails.[1]: 781–2
Psoriatic nails are characterized by a translucent discolouration in the nail bed that resembles a drop of oil beneath the nail plate.[2] Early signs that may accompany the "oil drop" include thickening of the lateral edges of the nail bed with or without resultant flattening or concavity of the nail; separation of the nail from the underlying nail bed, often in thin streaks from the tip-edge to the cuticle; sharp peaked "roof-ridge" raised lines from cuticle to tip; or separation of superficial layers of the nail followed by loss of patches of these superficial layers, leaving thin red nails beneath; or nail pitting–punctate changes along the nail plate surface.
The Nail Psoriasis Severity Index (NAPSI) is a numeric, reproducible, objective, simple tool for evaluation of nail psoriasis.[4] It evaluates several signs separately, each on a 1–3 scale: pitting, Beau's lines, subungual hyperkeratosis and onycholysis. A 2005 study proposed a modified NAPSI scale for persons with psoriasis and named the title of their publication "Modification of the Nail Psoriasis Severity Index".[5] Then, in 2007, a study found that there was a high level of inter-rater variability of the 2003 NAPSI scale and proposed another index which was, like the 2005 article, a modification of the 2003 article, and was named modified NAPSI.[6]
A 2008 study found that Cannavo's qualitative system[7] correlated with NAPSI (P<0.001) and is less time-consuming.[8]
Onycholysis: Separation of the nail plate from the nail bed
There exist numerous treatments for nail psoriasis but there is little information concerning their effectiveness and safety.[9]
Treatments include topical, intralesional, radiation, systemic, and combination therapies.
Tacalcitol ointment[10] obtains a significant improvement in all nail parameters, both of the matrix and of the bed.
Available studies lack sufficient power to extrapolate a standardized therapeutic regimen.[9]
As of April 2009, [needs update] an assessment of the evidence for the efficacy and safety of the treatments for nail psoriasis is in progress.[20]
Infliximab appears to be the most effective treatment for nail psoriasis to date.[21]
Results from low-dose acitretin therapy show NAPSI score reductions comparable with those studies evaluating biologic drugs for nail psoriasis and suggest that low-dose systemic acitretin should be considered in the treatment of nail psoriasis.[21]
A 2013 meta-analysis showed improvement of nail psoriasis with infliximab, golimumab, superficial radiotherapy, electron beam, and grenz rays compared to placebo.[22] Although systemic therapies have been shown to be beneficial, they may have serious adverse effects.[22]Topical treatments have not been well studied but may be beneficial.[22]
^James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN0-7216-2921-0.
^Kouskoukis, C.; Scher, R.; Ackerman, A. (1983). "The "oil drop" sign of psoriatic nails. A clinical finding specific for psoriasis". The American Journal of Dermatopathology. 5 (3): 259–262. doi:10.1097/00000372-198306000-00012. PMID6625117.
^Rich, P.; Scher, R. (2003). "Nail Psoriasis Severity Index: A useful tool for evaluation of nail psoriasis". Journal of the American Academy of Dermatology. 49 (2): 206–212. doi:10.1067/S0190-9622(03)00910-1. PMID12894066.
^Parrish, CA; Sobera, JO; Elewski, BE (October 2005). "Modification of the Nail Psoriasis Severity Index". Journal of the American Academy of Dermatology. 53 (4): 745–6, author reply 746–7. doi:10.1016/j.jaad.2004.11.044. PMID16198816.
^Cassell, S.; Bieber, J.; Rich, P.; Tutuncu, Z.; Lee, S.; Kalunian, K.; Wu, C.; Kavanaugh, A. (2007). "The modified Nail Psoriasis Severity Index: Validation of an instrument to assess psoriatic nail involvement in patients with psoriatic arthritis". The Journal of Rheumatology. 34 (1): 123–129. PMID17216680.
^Cannavò, S. P.; Guarneri, F.; Vaccaro, M.; Borgia, F.; Guarneri, B. (2003). "Treatment of Psoriatic Nails with Topical Cyclosporin: A Prospective, Randomized Placebo-Controlled Study". Dermatology. 206 (2): 153–156. doi:10.1159/000068469. PMID12592084. S2CID20866096.
^Kaçar, N.; Ergin, Ş.; Erdo?an, B. (2007). "The comparison of Nail Psoriasis Severity Index with a less time-consuming qualitative system". Journal of the European Academy of Dermatology and Venereology. 22 (2): 219–22. doi:10.1111/j.1468-3083.2007.02389.x. PMID18211416. S2CID41847018.
^ abJiaravuthisan, M. M.; Sasseville, D.; Vender, R. B.; Murphy, F.; Muhn, C. Y. (2007). "Psoriasis of the nail: Anatomy, pathology, clinical presentation, and a review of the literature on therapy". Journal of the American Academy of Dermatology. 57 (1): 1–27. doi:10.1016/j.jaad.2005.07.073. PMID17572277.
^Balbás, G. M.; Regaña, M. S.; Millet, P. U. (2009). "Tacalcitol ointment for the treatment of nail psoriasis". Journal of Dermatological Treatment. 20 (5): 308–310. doi:10.1080/09546630902787585. PMID19367480. S2CID208249471.
^Fiallo, P. (2009). "Yellow nails as an adverse reaction to the topical use of 5-fluorouracil for the treatment of nail psoriasis". Journal of Dermatological Treatment. 20 (5): 299–301. doi:10.1080/09546630902773494. PMID19363737. S2CID42262387.
^Rigopoulos, D.; Gregoriou, S.; Daniel, III, C. R.; Belyayeva, H.; Larios, G.; Verra, P.; Stamou, C.; Kontochristopoulos, G.; Avgerinou, G.; Katsambas, A. (2009). "Treatment of Nail Psoriasis with a Two-Compound Formulation of Calcipotriol plus Betamethasone Dipropionate Ointment". Dermatology. 218 (4): 338–341. doi:10.1159/000202179. PMID19212110. S2CID36470967.
^Lamerson, C.; Stevens, G.; Sax, K. (2008). "Treatment of nail psoriasis with efalizumab: A preliminary study". Cutis; Cutaneous Medicine for the Practitioner. 82 (3): 217–220. PMID18856162.
^Rigopoulos, D.; Gregoriou, S.; Stratigos, A.; Larios, G.; Korfitis, C.; Papaioannou, D.; Antoniou, C.; Ioannides, D. (2008). "Evaluation of the efficacy and safety of infliximab on psoriatic nails: An unblinded, nonrandomized, open-label study". British Journal of Dermatology. 159 (2): 453–456. doi:10.1111/j.1365-2133.2008.08686.x. PMID18565184. S2CID205257408.
^ abClinical trial number NCT00265096 for "A Study of the Safety and Efficacy of Golimumab in Patients With Active Psoriatic Arthritis (GO-REVEAL)" at ClinicalTrials.gov
^Saleem, K.; Azim, W. (2008). "Treatment of nail psoriasis with a modified regimen of steroid injections". Journal of the College of Physicians and Surgeons Pakistan. 18 (2): 78–81. PMID18454890.
^Clinical trial number NCT00581100 for "Effects of Etanercept on Nail Psoriasis and Plaque Psoriasis" at ClinicalTrials.gov
^Clinical trial number NCT00666354 for "Dose Response and Safety Study of Topical Methotrexate for the Treatment of Fingernail Psoriasis" at ClinicalTrials.gov