Psoriatic nails

Psoriatic nails
Classification and external resources
Psoriasis of a fingernail
ICD-10	L62.8

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]
• a thickening of the nail (normally at the tip) with ridges, pits and discolouration.

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 2007 study found that there was a high level of inter-rater variability and proposed a modified index, mNAPSI.^[4] A 2008 study found that Cannavo's qualitative system^[5] correlated with NAPSI (P<0.001) and is less time-consuming.^[6]

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.^[7]

Treatment

There exist numerous treatments for nail psoriasis but there is little information concerning their effectiveness and safety.^[8] Treatments include topical, intralesional, radiation, systemic, and combination therapies.

• Tacalcitol ointment^[9] obtains a significant improvement in all nail parameters, both of the matrix and of the bed.
• Clobetasol nail lacquer and tacalcitol ointment^[10]
• 5-fluorouracil. A reported side-effect is yellow nails^[11]
• Calcipotriol^[12]
• Calcipotriol plus betamethasone dipropionate ointment.^[13]
• Efalizumab ^[14]
• Infliximab^[15]
• Simponi.^[16]

• intralesional steroid injection^[17]

Relative effectiveness of treatments

Available studies lack sufficient power to extrapolate a standardized therapeutic regimen.^[8] As of April 2009, an assessment of the evidence for the efficacy and safety of the treatments for nail psoriasis is in progress.^[18]

• Infliximab appears to be the most effective treatment for nail psoriasis to date.^[19]
• 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.^[19]

Research

Active clinical trials investigating nail psoriasis:^[20]

Phase IV

• Effects of Etanercept.^[21]
• Effects of Simponi.^[16]

Phase II

• Dose response and safety of topical Methotrexate.^[22]

See also

• Psoriasis
• Nail disease

References

1. ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
2. ^ Kouskoukis, C.; Scher, R.; Ackerman, A. (1983). "The "oil drop" sign of psoriatic nails. A clinical finding specific for psoriasis". The American Journal of dermatopathology 5 (3): 259–262. PMID 6625117.  edit
3. ^ Rich, P.; Scher, R. (2003). "Nail Psoriasis Severity Index: A useful tool for evaluation of nail psoriasis". Journal of the American Academy of Dermatology 49 (2): 206–212. doi:10.1067/S0190-9622(03)00910-1. PMID 12894066.  edit
4. ^ Cassell, S.; Bieber, J.; Rich, P.; Tutuncu, Z.; Lee, S.; Kalunian, K.; Wu, C.; Kavanaugh, A. (2007). "The modified Nail Psoriasis Severity Index: Validation of an instrument to assess psoriatic nail involvement in patients with psoriatic arthritis". The Journal of rheumatology 34 (1): 123–129. PMID 17216680.  edit
5. ^ Cannavò, S. P.; Guarneri, F.; Vaccaro, M.; Borgia, F.; Guarneri, B. (2003). "Treatment of Psoriatic Nails with Topical Cyclosporin: A Prospective, Randomized Placebo-Controlled Study". Dermatology 206 (2): 153–156. doi:10.1159/000068469. PMID 12592084.  edit
6. ^ Kaçar, N.; Ergin, Ş.; Erdo?an, B. (2007). "The comparison of Nail Psoriasis Severity Index with a less time-consuming qualitative system". Journal of the European Academy of Dermatology and Venereology 0 (2): 070806200142002––. doi:10.1111/j.1468-3083.2007.02389.x. PMID 18211416.  edit
7. ^ Szepietowski, C.; Salomon, J. (Nov 2007). "Do fungi play a role in psoriatic nails?". Mycoses 50 (6): 437–442. doi:10.1111/j.1439-0507.2007.01405.x. ISSN 0933-7407. PMID 17944702.  edit
8. ^ ^{a b} Jiaravuthisan, M. M.; Sasseville, D.; Vender, R. B.; Murphy, F.; Muhn, C. Y. (2007). "Psoriasis of the nail: Anatomy, pathology, clinical presentation, and a review of the literature on therapy". Journal of the American Academy of Dermatology 57 (1): 1–27. doi:10.1016/j.jaad.2005.07.073. PMID 17572277.  edit
9. ^ Balbás, G. M.; Regaña, M. S.; Millet, P. U. (2009). "Tacalcitol ointment for the treatment of nail psoriasis". Journal of Dermatological Treatment 20 (5): 308–310. doi:10.1080/09546630902787585. PMID 19367480.  edit
10. ^ Snchez Regaa, M.; Mrquez Balbs, G.; Umbert Millet, P. (2008). "Nail psoriasis: A combined treatment with 8 clobetasol nail lacquer and tacalcitol ointment". Journal of the European Academy of Dermatology and Venereology 22 (8): 963–969. doi:10.1111/j.1468-3083.2008.02679.x. PMID 18410337.  edit
11. ^ Fiallo, P. (2009). "Yellow nails as an adverse reaction to the topical use of 5-fluorouracil for the treatment of nail psoriasis". Journal of Dermatological Treatment 20 (5): 299–301. doi:10.1080/09546630902773494. PMID 19363737.  edit
12. ^ Tzung, T.; Chen, C.; Yang, C.; Lo, P.; Chen, Y. (2008). "Calcipotriol used as monotherapy or combination therapy with betamethasone dipropionate in the treatment of nail psoriasis". Acta dermato-venereologica 88 (3): 279–280. doi:10.2340/00015555-0401. PMID 18480933.  edit
13. ^ Rigopoulos, D.; Gregoriou, S.; Daniel, Iii, C. R.; Belyayeva, H.; Larios, G.; Verra, P.; Stamou, C.; Kontochristopoulos, G. et al. (2009). "Treatment of Nail Psoriasis with a Two-Compound Formulation of Calcipotriol plus Betamethasone Dipropionate Ointment". Dermatology 218 (4): 338–341. doi:10.1159/000202179. PMID 19212110.  edit
14. ^ Lamerson, C.; Stevens, G.; Sax, K. (2008). "Treatment of nail psoriasis with efalizumab: A preliminary study". Cutis; cutaneous medicine for the practitioner 82 (3): 217–220. PMID 18856162.  edit
15. ^ Rigopoulos, D.; Gregoriou, S.; Stratigos, A.; Larios, G.; Korfitis, C.; Papaioannou, D.; Antoniou, C.; Ioannides, D. (2008). "Evaluation of the efficacy and safety of infliximab on psoriatic nails: An unblinded, nonrandomized, open-label study". British Journal of Dermatology 159 (2): 453–456. doi:10.1111/j.1365-2133.2008.08686.x. PMID 18565184.  edit
16. ^ ^{a b} ClinicalTrials.gov NCT00265096
17. ^ Saleem, K.; Azim, W. (2008). "Treatment of nail psoriasis with a modified regimen of steroid injections". Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 18 (2): 78–81. PMID 18454890.  edit
18. ^ doi:10.1002/14651858.CD007633
19. ^ ^{a b} Noiles, K.; Vender, R. (2009). "Nail psoriasis and biologics". Journal of cutaneous medicine and surgery 13 (1): 1–5. PMID 19298765.  edit
20. ^ clinicaltrials.gov
21. ^ ClinicalTrials.gov NCT00581100
22. ^ ClinicalTrials.gov NCT00666354

External links

• Nail psoriasis at Medscape

Parapsoriasis

Pityriasis lichenoides (Pityriasis lichenoides et varioliformis acuta, Pityriasis lichenoides chronica) · Lymphomatoid papulosis · Small plaque parapsoriasis (Digitate dermatosis, Xanthoerythrodermia perstans) · Large plaque parapsoriasis (Retiform parapsoriasis)

Other pityriasis

Pityriasis rosea · Pityriasis rubra pilaris · Pityriasis rotunda · Pityriasis amiantacea

Other lichenoid

Lichen planus	configuration: Annular lichen planus · Linear lichen planus morphology of lesion: Hypertrophic lichen planus · Atrophic lichen planus · Bullous lichen planus · Ulcerative lichen planus · Lichen planus actinicus · Lichen planus pigmentosus site of involvement: Mucosal lichen planus · Lichen planus of the nails · Peno-gingival syndrome · Vulvovaginal gingival syndrome overlap: Lichen planus–lichen sclerosus overlap syndrome · Lichen planus–lupus erythematosus overlap syndrome special forms: Hepatitis-associated lichen planus · Lichen planus pemphigoides
Other	Lichen nitidus · Lichen striatus · Lichen ruber moniliformis · Gianotti–Crosti syndrome ungrouped lichenoid eruptions: Erythema dyschromicum perstans · Idiopathic eruptive macular pigmentation · Keratosis lichenoides chronica · Kraurosis vulvae · Lichen sclerosus · Lichenoid dermatitis · Lichenoid reaction of graft-versus-host disease

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