Comparative microscopic analysis of nail clippings from patients with cutaneous psoriasis and psoriatic arthritis

Abstract

BACKGROUNDThe nail involvement in psoriasis is related to psoriatic arthritis and may represent a predictor of the disease.OBJECTIVESTo analyze, through nail clipping, clinically normal and dystrophic nails of patients with cutaneous psoriasis and psoriatic arthritis.METHODSThis is a cross-sectional multicenter study, conducted between August 2011 and March 2012. Patients were divided into four groups: patients with cutaneous psoriasis and onychodystrophy, patients with cutaneous psoriasis and clinically normal nails, patients with psoriatic arthritis and onychodystrophy and patients with psoriatic arthritis and clinically normal nails. We calculated NAPSI (Nail Psoriasis Severity Index) of the nail with more clinically noticeable change. After collection and preparation of the nail clipping, the following microscopic parameters were evaluated: thickness of the nail plate and subungual region, presence or absence of parakeratosis, serous lakes, blood, and fungi.RESULTSThere were more layers of parakeratosis (p=0.001) and a greater thickness of the subungual region in patients with cutaneous psoriasis and onychodystrophy (p=0.002). Serous lakes were also more present in the same group (p=0.008) and in patients with psoriatic arthritis and normal nails (p=0.047). The other microscopic parameters showed no significant difference between normal and dystrophic nails or between patients with psoriatic arthritis or cutaneous psoriasis.STUDY LIMITATIONSSmall sample size and use of medications.CONCLUSIONSNail clipping is a simple and quick method to assess the nails of patients with nail psoriasis although does not demonstrate difference between those with joint changes or exclusively cutaneous psoriasis.

Distal interphalangeal joint extensor tendon enthesopathy in patients with nail psoriasis

“…Anatomically, there is strong link between PsA and nail inflammation. Psoriatic changes in nails are a known risk factor for the development of arthritis 20,21 .…”

Nail Involvement in Patients with Psoriatic Arthritis in Northern Iran

“…We found that onycholysis, oil drop, and splinter hemorrhage, in particular, were significantly more prevalent in PsA patients. Fonseca et al found no statistical difference in NAPSI (Nail Psoriasis Severity Index) values among patients with or without psoriatic arthritis [ 20 ]. Perhaps, the type of nail involvement is more important than the severity of nail changes in terms of correlation with PsA.…”

“…However, there is still no clear explanation for this association and some believe that this association is limited only to distal interphalangeal (DIP) joints [ 22 ]. The suggested theories are (a) having a common (and yet unknown) autoantigen in both nail apparatus and synovial membrane, (b) anatomic connection between nail structures and DIP joints, and (c) the common role of trauma (Koebner phenomenon) in both nail and arthropathic psoriasis [ 20 , 23 , 24 ].…”

Clinical and histological spectrum of nail psoriasis: A cross‐sectional study

“…[8][9][10][11] Recently, the use of nail clipping microscopy as a diagnostic tool for nail psoriasis has also been studied. [12][13][14][15] Although there are many studies delineating the clinical features of nail psoriasis, very few have described the histopathological features, or tried to correlate the two. In an attempt to bridge this gap, this descriptive cross-sectional study was undertaken to study the histopathological features of nail psoriasis.…”

“…Recently, the use of nail clipping microscopy as a diagnostic tool for nail psoriasis has also been studied . Although there are many studies delineating the clinical features of nail psoriasis, very few have described the histopathological features, or tried to correlate the two.…”