Psoriatic nails
Encyclopedia
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.
, subungual hyperkeratosis and onycholysis
. A 2007 study found that there was a high level of inter-rater variability and proposed a modified index, mNAPSI.
A 2008 study found that Cannavo's qualitative system correlated with NAPSI (P<0.001) and is less time-consuming.
There is a risk of misdiagnosis with onychomycosis
.
Treatments include topical, intralesional, radiation, systemic, and combination therapies.
As of April 2009, an assessment of the evidence for the efficacy and safety of the treatments for nail psoriasis is in progress.
Nail disease
Nail diseases are distinct from diseases of the skin. Although nails are a skin appendage, they have their own signs and symptoms which may relate to other medical conditions. Nail conditions that show signs of infection or inflammation require medical assistance...
. It is common in those suffering from psoriasis
Psoriasis
Psoriasis is an autoimmune disease that appears on the skin. It occurs when the immune system mistakes the skin cells as a pathogen, and sends out faulty signals that speed up the growth cycle of skin cells. Psoriasis is not contagious. However, psoriasis has been linked to an increased risk of...
, with reported incidences varying from 10% to 78%. Elderly patients and those with psoriatic arthritis
Psoriatic arthritis
Psoriatic arthritis is a type of inflammatory arthritis that, according to the National Psoriasis Foundation, will develop in up to 30 percent of people who have the chronic skin condition psoriasis...
are more likely to have psoriatic nails.
Symptoms
- a translucent discolouration in the nail bed that resembles a drop of oil beneath the nail plate.
- 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. It evaluates several signs separately, each on a 1–3 scale: pitting, Beau's linesBeau's lines
Beau's lines are deep grooved lines that run from side to side on the fingernail. They may look like indentations or ridges in the nail plate. This condition of the nail was named by a French physician, Joseph Honoré Simon Beau , who first described it in 1846.Beau's lines are horizontal, going...
, subungual hyperkeratosis and onycholysis
Onycholysis
Onycholysis refers to the detachment of the nail from the nail bed, starting at its distal and/or lateral attachment. It is said to occur particularly on the ring finger but can occur on any of the fingernails. The most common cause of onycholysis is psoriasis. It can also occur in thyrotoxicosis...
. A 2007 study found that there was a high level of inter-rater variability and proposed a modified index, mNAPSI.
A 2008 study found that Cannavo's qualitative system correlated with NAPSI (P<0.001) and is less time-consuming.
There is a risk of misdiagnosis with onychomycosis
Onychomycosis
Onychomycosis means fungal infection of the nail. It is the most common disease of the nails and constitutes about a half of all nail abnormalities....
.
Causes
The causes of nail psoriasis are unknown. It has been suggested that fungi may play a role.Treatment
There exist numerous treatments for nail psoriasis but there is little information concerning their effectiveness and safety.Treatments include topical, intralesional, radiation, systemic, and combination therapies.
- TacalcitolTacalcitolTacalcitol is a synthetic vitamin D3 analog.Tacalcitol is marketed under several names, including Curatoderm and Bonalfa.-Mechanism:...
ointment obtains a significant improvement in all nail parameters, both of the matrix and of the bed. - Clobetasol nail lacquer and tacalcitol ointment
- 5-fluorouracil. A reported side-effect is yellow nails
- CalcipotriolCalcipotriolCalcipotriol or calcipotriene is a synthetic derivative of calcitriol or vitamin D. It is used in the treatment of psoriasis, marketed under the trade name Dovonex or Daivonex.-Mechanism:...
- CalcipotriolCalcipotriolCalcipotriol or calcipotriene is a synthetic derivative of calcitriol or vitamin D. It is used in the treatment of psoriasis, marketed under the trade name Dovonex or Daivonex.-Mechanism:...
plus betamethasone dipropionateBetamethasone dipropionateBetamethasone dipropionate is a glucocorticoid steroid with anti-inflammatory and immunosuppressive abilities. It is applied as a topical cream, ointment, lotion or gel to treat itching and other minor skin conditions such as eczema....
ointment. - EfalizumabEfalizumabEfalizumab is a formerly available medication designed to treat autoimmune diseases, origianally marketed to treat psoriasis. As implied by the suffix -zumab, it is a recombinant humanized monoclonal antibody administered once weekly by subcutaneous injection...
- InfliximabInfliximabInfliximab is a monoclonal antibody against tumour necrosis factor alpha . It is used to treat autoimmune diseases. Remicade is marketed by Janssen Biotech, Inc...
- Simponi.
- intralesional steroid injection
Relative effectiveness of treatments
Available studies lack sufficient power to extrapolate a standardized therapeutic regimen.As of April 2009, an assessment of the evidence for the efficacy and safety of the treatments for nail psoriasis is in progress.
- Infliximab appears to be the most effective treatment for nail psoriasis to date.
- 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.