Psoriatic onychodystrophy

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Psoriatic onychodystrophy
Other namesPsoriatic nails
A picture of a pair of feet in sandals. Some of the nails appear diseased.
Psoriasis of the toenails
SpecialtyDermatology
CausesPsoriasis
Differential diagnosisOnychomycosis
TreatmentMedications, radiation
Frequency10% to 78% of those with psoriasis

Psoriatic onychodystrophy or psoriatic 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 

Symptoms

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.

Causes

The causes of nail psoriasis are unknown. It has been suggested that fungi may play a role.[3]

Diagnosis

The Nail Psoriasis Severity Index (NAPSI) is a numeric, reproducible, objective, simple tool for evaluation of nail psoriasis.

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 is a risk of misdiagnosis with onychomycosis.

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, [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]

Research

Active clinical trials investigating nail psoriasis:[23]

Phase IV

Phase II

See also

References

  1. ISBN 0-7216-2921-0
    .
  2. PMID 6625117
    .
  3. S2CID 37127086
    .
  4. PMID 12894066
    .
  5. PMID 16198816
    .
  6. PMID 17216680
    .
  7. S2CID 20866096
    .
  8. S2CID 41847018
    .
  9. ^
    PMID 17572277
    .
  10. S2CID 208249471
    .
  11. PMID 18410337
    .
  12. S2CID 42262387
    .
  13. PMID 18480933
    .
  14. S2CID 36470967
    .
  15. PMID 18856162
    .
  16. S2CID 205257408
    .
  17. ^ a b Clinical trial number NCT00265096 for "A Study of the Safety and Efficacy of Golimumab in Patients With Active Psoriatic Arthritis (GO-REVEAL)" at ClinicalTrials.gov
  18. PMID 19951644
    .
  19. PMID 18454890
    .
  20. PMID 23440816
    .
  21. ^
    S2CID 26612674
    .
  22. ^
    PMID 23440816
    .
  23. ^ clinicaltrials.gov
  24. ^ Clinical trial number NCT00581100 for "Effects of Etanercept on Nail Psoriasis and Plaque Psoriasis" at ClinicalTrials.gov
  25. ^ Clinical trial number NCT00666354 for "Dose Response and Safety Study of Topical Methotrexate for the Treatment of Fingernail Psoriasis" at ClinicalTrials.gov

External links


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