Frequency and pattern of nail changes in patients with psoriasis vulgaris
Keywords:
Nail psoriasis, psoriatic arthritis, subungual hyperkeratosis, onycholysis, oil drop signAbstract
Background Nails can be involved in up to 50% of psoriatics but less than 5% of cases of nail psoriasis have been reported even in the absence of classical skin lesions. Nail changes are often associated with psoriatic arthritis. Severe nail psoriasis can lead to functional and social impairment if left untreated. However, psoriatic nail disease is often overlooked in the clinical practice and therapeutic trials.  Objective To determine frequency and pattern of nail changes in patients with psoriasis vulgaris and their correlation with severity of the disease. Patients and methods Clinically diagnosed cases of psoriasis vulgaris with concurrent nail changes, irrespective of the duration and severity of their illness, were enrolled. Detailed cutaneous and nail examination was performed. Severity of the dermatological disease was graded as mild, moderate and severe. Skin biopsy was performed in doubtful cases. Statistical analysis was carried out using the micro software SPSS 13.  Results One hundred two patients, comprising 55 males (54%) and 47 females (46%), with minimum age of presentation 16 years and maximum 66 years completed the study. Mean age of presentation was 40.9±12.7 years. Joint involvement in the form of joint pain or restricted movements was observed in 55 patients (54%). Nails were involved in 59 patients (58%, P=0.05) comprising 32 males (54%) and 27 females (46%). Of the 55 patients with joint involvement, 39 (71%) had their nails affected. Of the 59 patients with nail psoriasis, 49 (83%) had been suffering from psoriasis for more than 5 years. 27 (46%) had their fingernails involved, 19 (32%) toenail psoriasis while 13 (22%) patients had both sites involved. Of the 59 patients with nail disease, 5 (8.5%) had mild psoriasis, 38 (64.5%) moderate skin disease and remaining 16 (27%) severe psoriasis vulgaris. The most frequent nail finding was roughening seen in 55 patients (93%) followed by transverse ridging and pitting, color change, thickening, dystrophy, subungual hyperkeratosis, onycholysis and leukonychia. Conclusion Nail changes are a frequent feature of psoriasis vulgaris and ridging, pitting and roughening being the most common. Nail dystrophy, color change, onycholysis, leukonychia and subungual hyperkeratosis are the other associated findings.ÂReferences
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