Prevalence, clinical profile, and severity of nail involvement in psoriasis – A hospital-based cross-sectional study from a tertiary care center in North Kerala

Objectives: Nail changes are present in 25–50% of psoriatic cases. Nail Psoriasis Severity Index (NAPSI) assess the extent of the involvement of the psoriatic nail unit. This study was conducted with the aim of finding the prevalence, clinical characteristics and severity of nail psoriasis. Methods and Materials: In this cross-sectional study, a thorough clinical examination was done to determine the type and extent of skin disease including PASI (psoriasis area severity index) score, and all the fingernails and toenails were examined in a well-lit environment, under a magnifying lens to visualize the nail findings, and NAPSI score was calculated for each patient. Statistical Package for the Social Sciences (SPSS v. 11.0) software was used to analyze the data collected. Results: Of the100 patients studied, 73% of patients with psoriasis had nail involvement. Mean total NAPSI was 30.97 ± 30.79. Mean age of onset of psoriasis was 43.62 ± 15.31 and 33.04 ± 12.80 in those with and without nail involvement respectively (P-value 0.002). The majority without nail involvement (77.8%) belonged to the early- onset group, while 22.2% of those without nail involvement had late-onset psoriasis (P-value 0.001). The most common nail pattern in our study was Pitting (93.2%). Limitation: Nail changes in severe forms of disease could not be studied since patients receiving systemic drugs for the disease were excluded from the study. Conclusion: The mean duration of psoriasis in those with nail involvement in our study was 5 years more than in those without nail disease. Our study demonstrated a significant association between higher PASI scores and nail involvement. All patients with severe psoriasis (PASI >20) in our study had nail involvement.