National Skin Centre, Singapore.
Am J Clin Dermatol. 2012 Dec 1;13(6):375-88. doi: 10.2165/11597000-000000000-00000.
Nail psoriasis is common, occurring in up to half of patients with psoriasis and in 90% of patients with psoriatic arthritis. Left untreated, it may progress to debilitating nail disease, which leads to significant functional impairment. The most common clinical signs of nail psoriasis are nail plate pitting and onycholysis. Other classical signs include oil drop discoloration, subungual hyperkeratosis, and splinter hemorrhages. The modified Nail Psoriasis Severity Index (mNAPSI) can be used to grade the severity of nail psoriasis, while the Nail Psoriasis Quality of Life Scale (NPQ10) is a questionnaire that evaluates the impact of nail psoriasis on the patient's functional status and quality of life. Treatment of nail psoriasis should be individualized according to the patient's preferences, severity of nail changes, and presence of skin and/or joint involvement. Both topical and intralesional therapies are safe and effective treatment modalities for nail disease, but are limited by poor adherence and pain, respectively. Systemic therapy such as oral retinoids may be considered for widespread nail disease causing significant morbidity. Among biologic agents, tumor necrosis factor-α inhibitors and T-cell-targeted therapies such as ustekinumab may be useful for refractory severe nail psoriasis.
甲银屑病很常见，可发生于多达一半的银屑病患者和 90%的银屑病关节炎患者中。如果不治疗，它可能进展为使人衰弱的甲病，导致严重的功能障碍。甲银屑病最常见的临床征象是甲板凹陷和甲分离。其他典型征象包括油滴变色、甲下过度角化和裂片形出血。改良的甲银屑病严重程度指数（mNAPSI）可用于分级甲银屑病的严重程度，而甲银屑病生活质量量表（NPQ10）是评估甲银屑病对患者功能状态和生活质量影响的问卷。甲银屑病的治疗应根据患者的偏好、甲改变的严重程度以及皮肤和/或关节受累情况进行个体化。局部和皮损内治疗都是安全有效的甲病治疗方法，但分别受到患者顺应性差和疼痛的限制。对于广泛的甲病导致严重发病率的患者，可考虑全身性治疗，如口服维 A 酸类药物。在生物制剂中，肿瘤坏死因子-α抑制剂和针对 T 细胞的治疗药物，如乌司奴单抗，可能对难治性严重甲银屑病有用。
