Evaluation of Nail Psoriasis: Delving into Some Useful Scores

Abstract

Introduction: Several scoring systems have been established for nail psoriasis severity assessment. However, there is a lack of consensus on these tools.

Objectives: To evaluate the nail changes in psoriasis patients and to correlate the severity of nail findings by Nail Psoriasis Severity Index (NAPSI) and modified NAPSI (m-NAPSI) scores.

Material and Methods: Three hundred and seventy consecutive adult psoriatic patients were studied to describe the pattern of nail changes with its frequency and the findings were compared with data collected on age-and gender-matched 150 control subjects to determine which of the observed features are psoriasis disease-specific nail changes. The nail severity was assessed by NAPSI and m-NAPSI scores and correlated. 

Results: Nail signs included in NAPSI were more commonly seen in psoriatic patients as compared to healthy controls and it was statistically significant. Beau’s line was also found more in patients as compared to controls. None of the cases and controls had red spots in the lunula, and leukonychia was comparatively common in the controls. There was a strong and significant correlation found between NAPSI and m-NAPSI (r=0.916). Fingernails had a stronger correlation as compared to toenails between NAPSI and m-NAPSI (r=0.920 vs. r=0.877; p<0.001).

Conclusions: m-NAPSI may be considered to measure the degree of nail changes however leukonychia and a red spot in the lunula could be removed and Beau’s line could be added as further modification of m-NAPSI.