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Psoriatic nails

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Psoriatic nails

Psoriatic nails
Classification and external resources
10 62.8

Psoriatic nails is a nail disease. It is common in those suffering from 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

Symptoms

  • a translucent discolouration in the nail bed that resembles a drop of oil beneath the nail plate.[2]

Diagnosis

The Nail Psoriasis Severity Index (NAPSI) is a numeric, reproducible, objective, simple tool for evaluation of nail psoriasis.[3] 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".[4] 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.[5] A 2008 study found that Cannavo's qualitative system[6] correlated with NAPSI (P<0.001) and is less time-consuming.[7]

There is a risk of misdiagnosis with onychomycosis.

Causes

The causes of nail psoriasis are unknown. It has been suggested that fungi may play a role.[8]

Treatment

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.

Relative effectiveness of treatments

Available studies lack sufficient power to extrapolate a standardized therapeutic regimen.[9] As of April 2009, 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]

Research

Active clinical trials investigating nail psoriasis:[22]

Phase IV

Phase II

See also

References

External links

  • Nail psoriasis at Medscape
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