Nail changes in psoriasis: A hospital based clinico-epidemiological study

Abstract

Background  Psoriasis is a common immune mediated, multifactorial disease which is caused by genetic heterogeneity and phenotypic diversities.1 It is characterized by red, scaly, sharply demarcated, indurate plaques mostly over scalp and extensor surface affecting 2-3% global population.3,4 Beside cutaneous involvement, nail involvement is quite common in psoriasis patient (50%) and 5% cases had only nail involvement.5,6   Objective To assess the frequency, types of nail involvement in psoriasis patient and its association with the disease severity.   Methods Institution based Cross-sectional study on 100 consecutive patients attending Outpatient department was done for a period of 1 year March 2019 to February 2020.   Results 48% have nail changes with male having twice that of female. The mean age of the patients having nail changes was 42.450 with SD 13. Isolated finger nail and Toe nail involvement was noted in 52% and 1%, while 46% have both. Majority nail changes were pitting (68%), distal onycholysis (38%), longitudinal ridging (25%), subungual hyperkeratosis 22%, proximal onycholysis 19%, transverse ridging 8% etc.77% patient with nail changes has disease duration less than 5 years. Frequency of nail changes was noted highest in patient with severe disease (64.58%).   Conclusion Psoriatic nail changes are common in psoriasis patients. Severe nail psoriasis can lead to functional and social impairment if left untreated.  An association was noted between severity of psoriasis and nail changes but elaborate study with large samples are required to establish that relationship.