Prevalence, severity and clinical features of psoriasis in fingernails and toenails in adult patients: Italian experience
ABSTRACT Background Psoriasis is a chronic inflammatory skin disease affecting 2.0-6.5% of the European population. Although the most striking clinical features of psoriasis involve the skin, other organs including nails and joints may be affected in a substantial proportion of patients. Literature reports nail involvement in 10-56% of psoriatic patients, with common physical and social impairment. However, the precise prevalence of specific clinical features of nail psoriasis is somewhat under-reported. Objectives Our cross-sectional study aimed at describing the prevalence and the clinical features of nail involvement in adult psoriatic patients in a psoriasis referral centre in northern Italy. Methods A total of 178 (124 men, 54 women) consecutive adult patients (≥18 years old) with psoriasis were included. Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI) scores were calculated for each patient. Relevant medical history was recorded. Results Nail involvement was present in 137 (99 men, 38 women) patients (76.9%). The most common nail abnormality was onycholysis, followed by crumbling, subungual hyperkeratosis, pitting and discoloration. Pitting and onycholysis were the most prevalent patterns observed in fingernails, whereas onycholysis and crumbling were the most frequent changes detected in toenails. The most frequently and severely affected nails were the fourth fingernail and the first toenail. The average PASI score was higher in individuals with nail involvement (12.0 vs. 8.7, P = 0.06). Nail changes were present in 85.7% of patients with psoriatic arthritis. Conclusions Our study confirms that nail involvement may be overlooked in psoriasis patients. Different psoriatic patterns in the nail affect specific digits more frequently.
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ABSTRACT: Nail psoriasis is usually investigated and diagnosed by clinical examination. Ultrasonography is a non-invasive imaging technique for studying soft tissue involvement. The objective of this study was to estimate nail involvement in patients with chronic plaque psoriasis by ultrasonography. Prevalence, clinical type and severity of nail involvement according to nail psoriasis and severity index (NAPSI) were investigated in 138 patients with psoriasis. The thickness of the plate and bed of the fingernails was measured in 54 patients with psoriasis, 46 healthy controls and 37 patients with chronic eczema, using an ultrasonographic system equipped with a frequency transducer of 18 MHz. The prevalence of nail psoriasis was 73 % (102 out of 138). Onycholysis and thickening of the nail plate were the most common clinical type affecting 56 and 50 % of patients, respectively; splinter haemorrhages was the less common involving 10 % of patients. The mean NAPSI score was 18.4 ± 17.5 (SD; range 0-107). The thickness of fingernail plate and bed was significantly higher in patients with psoriasis with nail disease compared to healthy controls and patients with chronic eczema (p < 0.001). There was a linear correlation between NAPSI and plate and bed nail thickness (r = 0.52 and r = 0.38, p = 0.001). Increased nail plate and bed thickness was observed also in patients with psoriasis without clinically apparent nail involvement. In conclusion, thickening of the nail is a common feature of nail psoriasis also in patients without clinically apparent nail involvement.Archives for Dermatological Research 08/2012; 304(9):727-32. DOI:10.1007/s00403-012-1274-9 · 2.27 Impact Factor
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ABSTRACT: Background: Nail psoriasis is common in patients with psoriasis and can seriously affect their quality of life. Current treatments are limited and there is no standard course of therapy. Objectives: The objective of the NAIL study was to assess the efficacy and safety of etanercept (ETN) on nail psoriasis in patients with moderate-to-severe psoriasis. Methods: Patients with moderate-to-severe plaque psoriasis, who had previously failed at least one form of systemic therapy for nail psoriasis, were randomised to receive open-label ETN 50 mg twice weekly (BIW) for 12 weeks followed by once weekly (QW) for 12 weeks (BIW/QW group) or ETN 50 mg QW for 24 weeks (QW/QW group). The primary endpoint was the mean improvement in the nail psoriasis severity index (NAPSI; score range 0-8) over 24 weeks in the target fingernail with the most severe abnormalities. Results: 72 patients received ≥1 dose of ETN (38 BIW/QW; 34 QW/QW) and 69 patients were included in the modified intent-to-treat population. At baseline, mean (standard error [SE]) target fingernail NAPSI was 6.0 (0.3) in the BIW/QW group and 5.8 (0.3) in the QW/QW group. At Week 24, mean target fingernail NAPSI score had decreased significantly by -4.3 (95% confidence interval [CI] -4.9, -3.7; P<0.0001) in the BIW/QW group and by -4.4 (95% CI -5.0, -3.7; P<0.0001) in the QW/QW group. Improvement in NAPSI showed significant correlation with PASI improvement. ETN was well-tolerated with no unexpected safety findings. Conclusions: Both ETN regimens were effective at treating nail psoriasis in this patient population.British Journal of Dermatology 09/2012; 168(5). DOI:10.1111/bjd.12060 · 4.10 Impact Factor
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ABSTRACT: Abstract Objective: To describe biologic treatment patterns and effectiveness among patients with psoriasis who initiated biologic therapy. Methods: A chart review was conducted for 169 patients with psoriasis initiating biologic treatment between 01July2005 and 30June2009 from six dermatology clinics. Severity was measured by the Psoriasis Area and Severity Index (PASI) at baseline and time of treatment change. Biologic treatment patterns in the 12 months following initiation (discontinuation, switching, dose increase, and persistence) were collected. Results: Mean (SD) PASI score at initiation was 18.4 (7.8). Eighteen percent of patients discontinued biologic use, 12% switched, and 7% increased biologic dose within the first 12 months. Patients persistent on initial biologic therapy (64%) achieved a mean PASI score of 3.8 at 12 months; 69% achieved PASI >75. For patients who discontinued due to lack of effectiveness, mean PASI score was 22.6; no patient reached PASI >75. Among patients who switched, mean PASI was 15.7 (0% PASI >75) at the time of switch. In those who increased their dose, mean PASI score was 9.1 (43% reached PASI >75) at the time of dose increase. Conclusions: A large proportion (36%) of patients changed or discontinued biologic therapy within the first year. These patients experienced limited PASI response, if any, suggesting an unmet need for this population.Journal of Dermatological Treatment 01/2013; 25(1). DOI:10.3109/09546634.2013.768762 · 1.76 Impact Factor