Nail involvement in adult patients with plaque-type psoriasis: prevalence and clinical features

Abstract

BACKGROUND:Psoriasis is a disease of worldwide distribution with a prevalence of 1 to 3%. Nail psoriasis is estimated in 50% of patients with psoriasis, and in the presence of joint involvement, it can reach 80%.OBJECTIVE:To study the nail changes - and their clinical implications - presented by patients with psoriasis vulgaris under surveillance in a university hospital from the south of Brazil.METHODS:his cross-sectional study evaluated 65 adult patients from January 2012 to March 2013. Cutaneous severity was assessed according to the Psoriasis Area and Severity Index (PASI). The Nail Psoriasis Severity Index (NAPSI) was used to evaluate patient's nails. The diagnosis of psoriatic arthritis was established according to the Classification Criteria for Psoriatic Arthritis (CASPAR).RESULTS:The prevalence of NP was 46.1%. These patients had a median [interquartilic range (IQR)] NAPSI of 1 (0-15). A total of 63.3% of patients reported aesthetic discomfort or functional impairment related to their nails. Onycholysis was the most common feature (80%). When compared with patients without nail involvement, patients with NP had lower mean age at psoriasis onset [21 (18-41) vs. 43 (30-56) years, p=0,001]; longer disease duration [15.5 (10-24) vs. 6 (2-12) years, p=0.001]; higher PASI [9.2 (5-17) vs. 3.7 (2-10), p=0.044], higher frequency of psoriatic arthritis (43.3 vs. 3.7, p = 0.002) and more often reported family history of psoriasis (40% vs. 7.4%, p = 0.011).CONCLUSION:Onycholysis was the most frequent finding and most patients feel uncomfortable with the psoriatic nail changes that they experience.

Prevalence of onychomycosis among patients with nail psoriasis who are not receiving immunosuppressive agents: Results of a pilot study

“…Few studies, also examining only nail psoriasis patients found a substantially higher prevalence of onychomycosis among them; it is possible that the inclusion of patients currently being or having recently been treated with immunosuppressive agents can justify the noted difference . The majority of studies examining psoriasis patients with as well as without psoriatic nail lesions have reported a smaller prevalence of onychomycosis than the one found in our study . This discrepancy is possibly attributed to the fact that psoriasis patients with clinically healthy nails seem to be less susceptible to dermatophyte infections of the nail than the general population.…”

“…[38][39][40] The majority of studies examining psoriasis patients with as well as without psoriatic nail lesions have reported a smaller prevalence of onychomycosis than the one found in our study. 8,13,[41][42][43][44][45][46][47] This discrepancy is possibly attributed to the fact that psoriasis patients with clinically healthy nails seem to be less susceptible to dermatophyte infections of the nail than the general Case, infection proved through mycological testing; n, natural number; Percentage, refers to the total of infection cases.…”

“…Its worldwide prevalence is 2%‐3% . According to literature, 10%‐80% of psoriasis patients manifest nail lesions attributed to their disease . Approximately, 5% of them present only with nail lesions and no skin lesions at all .…”

“…1,[4][5][6] According to literature, 10%-80% of psoriasis patients manifest nail lesions attributed to their disease. 3,7,8 Approximately, 5% of them present only with nail lesions and no skin lesions at all. 7,9 However, nail psoriasis often cannot be clinically distinguished from onychomycosis.…”

The microvascular and morphostructural changes of nails in psoriatic patients with nail disease; a link between ultrasound and videocapillaroscopy findings in the nailfold

“…Van Laborde et al have shown that there is an 80% to 90% lifetime incidence of nail involvement in psoriatic patients [4]. The presence of nail involvement of psoriasis is associated with an increase in patient-reported pain complaints, functional impairment and social burden, resulting in a significant restriction of daily activities and quality of life as well as resistance to treatment [5][6][7][8][9].…”