Wanniang Naphisabet, Navya Annam, Pai Varadraj, Ghodge Rakhi
Department of Dermatology, Goa Medical College, Goa, India.
Indian Dermatol Online J. 2020 Jan 13;11(1):35-40. doi: 10.4103/idoj.IDOJ_51_19. eCollection 2020 Jan-Feb.
Nail changes have been reported in approximately 40% of psoriasis patients. Occasionally nail psoriasis may be the sole finding or the first presentation of the disease. Assessment of the nail changes associated with psoriasis can be done clinically, ultrasonographically, and most recently using a dermoscope. The aim of this study is to assess the dermoscopic features in nails of psoriasis as well as to compare the dermoscopic with the clinical findings. This study has also assessed the correlation between disease duration and the severity of skin and nail involvement.
A total of 50 patients with psoriatic nail changes were recruited in the study. The psoriasis area severity index (PASI) was used to assess the severity of the disease. The nail psoriasis severity index (NAPSI) was used to determine the severity of nail involvement. The patient's nails were examined both clinically and dermoscopically.
Pitting was the commonest feature (84%) noted both clinically and dermoscopically. A statistically significant higher NAPSI score ( < 0.05) was obtained by a dermoscope than by clinical examination. Salmon patch and splinter hemorrhage were better visualized using a dermoscope than by clinical evaluation ( < 0.05). The duration of the disease had a strong positive correlation ( = 0.901) with the duration of nail involvement whereas there was a weak correlation between the duration of the disease and the clinical NAPSI ( = 0.23) and dermoscopic NAPSI ( = 0.28). A weak positive correlation ( = 0.3) was noted between the PASI and NAPSI scores.
Dermoscopy of nails proved to be an efficient, supportive, easy, noninvasive method that provides a better insight into the subtle nail changes in psoriatic patients, which may have been missed clinically.
背景、目的和目标：据报道，约40%的银屑病患者存在指甲改变。偶尔，指甲银屑病可能是该病的唯一表现或首发症状。银屑病相关指甲改变的评估可通过临床、超声检查，以及最近使用的皮肤镜进行。本研究的目的是评估银屑病指甲的皮肤镜特征，并将皮肤镜检查结果与临床发现进行比较。本研究还评估了病程与皮肤和指甲受累严重程度之间的相关性。
本研究共招募了50例有银屑病指甲改变的患者。采用银屑病面积和严重程度指数（PASI）评估疾病严重程度。采用指甲银屑病严重程度指数（NAPSI）确定指甲受累的严重程度。对患者的指甲进行临床和皮肤镜检查。
点状凹陷是临床和皮肤镜检查中最常见的特征（84%）。皮肤镜检查获得的NAPSI评分在统计学上显著高于临床检查（<0.05）。使用皮肤镜观察鲑鱼色斑和裂片形出血比临床评估更清晰（<0.05）。病程与指甲受累时间呈强正相关（=0.901），而病程与临床NAPSI（=0.23）和皮肤镜NAPSI（=0.28）之间的相关性较弱。PASI与NAPSI评分之间呈弱正相关（=0.3）。
指甲皮肤镜检查被证明是一种有效、辅助、简便、无创的方法，能更好地洞察银屑病患者细微的指甲改变，而这些改变在临床上可能被遗漏。
