Cross sectional study to correlate clinical severity of nail changes using napsi scoring and dermoscopic nail changes in patients of psoriasis

Abstract

Introduction: Nail psoriasis is a common, often misdiagnosed disease affecting patients both functionally and psychologically. Nail involvement occurs in approximately in 40% - 50 % of patients suffering from cutaneous psoriasis and in 5 % of the patient as a sole presentation. Nail changes associated with psoriasis are mostly asymptomatic in the initial stages of the disease and may be the first presentation, hence examination and evaluation of the nail changes routinelyis of foremost importance. An objective scoring system called nail psoriasis severity index (NAPSI) has been devised which is a simple, reproducible tool to observe the nail changes in psoriasis as well as to assess the efficacy of various therapeutic modalities. Nail matrix involvement leads to pitting, red spots in the lunula, crumbling and leukonychia while nail bed involvement presents with onycholysis, oil spots, subungual hyperkeratosis and splinter haemorrhages. A dermoscope is a non-invasive, diagnostic tool which is used to examine the minute presenting patterns of skin lesions and also the subsurface skin structures which are invisible to the eye. The term “onychoscopy” was coined for dermoscopic examination of nail unit. It holds a distinct place in the diagnostic work up of nail disorders by enhancing the visible nail features and subtle non visible features. Objective: To find a correlation between the onychoscopic nail changes with clinical severity of nail changes through NAPSI scoring in psoriasis patients with nail changes. Our secondary objective was to find a correlation between clinical severity using PASI score and severity of nail changes using NAPSI score.