Clinical and onychoscopic evaluation of nail changes in psoriasis at a tertiary-care hospital: A cross-sectional study

Abstract

Background: Up to 30–50% of cases of psoriasis experience nail involvement, while 5–10% may have only isolated nail disease. Recently, the use of onychoscopy, a non-invasive technology, has emerged as a promising tool that may eliminate the necessity of a nail biopsy in most cases. Objective: The objective of this study was to assess the onychoscopic characteristics of the nail unit in individuals with nail psoriasis. Materials and Methods: The study recruited fifty patients with a clinical diagnosis of nail psoriasis. Each nail underwent onychoscopic assessment. The clinical degree of cutaneous and nail involvement was evaluated with the Psoriasis Area and Severity Index (PASI) and the Nail Psoriasis Severity Index (NAPSI), respectively. Results: The following findings were observed significantly more often on onychoscopy than with the naked eye: pitting (p = 0.03), leukonychia (p = 0.04), onycholysis (p = 0.04), and splinted hemorrhage (p = 0.05). The other novel findings included fuzzy lunula, which was only onychoscopically (8%), We also encountered 4% of cases of triangular onychomadesis and 6% of non-traumatic Median canaliform dystrophy of Heller. Conclusion: Our findings suggest that, even before clinical symptoms become obvious, onychoscopy may help with nail lesion diagnosis. Key words: Onychoscopy; Nail Psoriasis; Psoriasis; Nail Pitting; Fuzzy Lunula; Triangular Onychomadesis