Clinico-Epidemiological Characteristics and Impact on Quality of Life in Psoriatic Patients with and without Nail Changes - A Nepalese Experience

2021 ◽  
Vol 8 (06) ◽  
pp. 306-312
Author(s):  
Shikha Khare ◽  
Sudha Agrawal
Keyword(s):  
Quality Of Life ◽  
Age Of Onset ◽  
Severity Index ◽  
Joint Involvement ◽  
Skin Involvement ◽  
Nail Psoriasis ◽  
Nail Changes ◽  
Epidemiological Characteristics ◽  
Nail Involvement

BACKGROUND Nail involvement in psoriasis is likely to influence the quality of life (QOL) because of its highly visible site; however, the impact of this disease on QOL is an underexplored area. Similarly, the relationship between severity of skin involvement and nail involvement has been overlooked. The study was conducted to evaluate the clinico-epidemiological characteristics of psoriasis patients with and without nail changes and assess the health-related quality of life (HRQOL). Furthermore, the correlation of severity of nail involvement with the severity of skin involvement and its impact on quality of life was assessed. METHODS A total of 370 adult psoriasis patients with or without nail changes was studied. Skin severity was assessed by body surface area (BSA) and Psoriasis Area and Severity Index (PASI) while nail severity was assessed using Nail Psoriasis Severity Index (NAPSI). Patients’ quality of life was measured using the Nepali Version of Dermatology Life Quality Index (DLQI). RESULTS Nail psoriasis was more prevalent in males in both the groups; females were having more nail involvement (0.041). There were no significant diff erences in other clinico-epidemiologic characteristics between these two groups except the late onset of psoriasis in the age group > 30 years, scalp involvement and absence of family history of psoriasis (P ≤ 0.05). There was a strong positive correlation between the age of onset of skin changes with age of onset of nail involvement (r = 0.799) and the joint involvement (r = 0.742) as well as the age of onset of joint involvement with nail changes (r = 0.838). The mean PASI was 7.265 ± 7.153 vs. 6.189 ± 7.153 in patients with > 10 vs. ≤ 10 total NAPSI score and it was statistically significant (P = 0.011), however, there was a moderate positive correlation between PASI and NAPSI (r = 0.32). Almost half of psoriasis patients had very large to extremely large effects on quality of life but leisure and treatment domain were affected more amongst patients with nail changes. Early onset of joint involvement, body surface area of > 3 % involvement and PASI score > 5 had significant effect on quality of life. CONCLUSIONS The nail involvement is an important finding in determining the severity of skin involvement and had very large to extremely large effect on quality of life particular on leisure and treatment domain. Therefore, nail examination must be done in all psoriatic patients. KEYWORDS Nail Psoriasis, Quality of Life, Dermatology Life Quality Index, Psoriasis Area and Severity Index, Nail Psoriasis Severity Index

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

2019 ◽  
Vol 1 ◽  
pp. 72-76
Author(s):  
Vivek Prabhakar ◽  
Bifi Joy ◽  
Anoop Thyvalappil ◽  
Rajiv Sridharan ◽  
Ajayakumar Sreenivasan ◽  
...  
Keyword(s):  
Age Of Onset ◽  
Late Onset ◽  
Tertiary Care ◽  
Severity Index ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Nail Psoriasis ◽  
Nail Changes ◽  
Nail Involvement

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.

scholarly journals Patterns of clinical nail appearances in patients with cutaneous psoriasis

2017 ◽  
Vol 90 (1) ◽  
pp. 22-27
Author(s):  
Elena Mihaela Marina ◽  
Carolina Botar-Jid ◽  
Sorana Daniela Bolboaca ◽  
Iulia Ioana Roman ◽  
Corina Simona Senila ◽  
...  
Keyword(s):  
Age Of Onset ◽  
Early Stage ◽  
Severity Index ◽  
University Hospital ◽  
Joint Involvement ◽  
Early Stage Disease ◽  
North West ◽  
The North ◽  
Plaque Type ◽  
Nail Changes

Background and aims. Nail manifestations are often an overlooked aspect in psoriatic disease, cutaneous and joint involvement being far more often reported and investigated. The reported prevalence of nail changes varies in literature, specific fingernail clinical features having different degrees of occurrence. The aim of this study was to describe specific clinical patterns of fingernail alterations in adult patients with plaque-type psoriasis in a university hospital in the North-West of Romania.Methods. Clinical data of 35 patients with fingernail psoriasis were collected and analyzed. Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI) scores were used to quantify disease extension in each patient.Results. PASI score proved linearly correlated with NAPSI score (p<0.05). The age of onset of fingernail psoriasis was positively correlated with age of onset cutaneous psoriasis (p<0.0001). Furthermore, the duration of cutaneous involvement and NAPSI proved significantly related (p<0.05). The third fingernail in the right hand and first fingernail in the left hand were in most of the cases severely affected. The most common observed nail pattern was pitting, followed by salmon patches and subungual hyperkeratosis.Conclusion. Important nail changes appear even in moderate forms of cutaneous psoriasis. Particular localization of specific fingernail psoriasis pattern enables the possibility of detecting early stage disease.

Psoriatic Nail Disease: Quality of Life and Treatment

2009 ◽  
Vol 13 (5_suppl) ◽  
pp. S102-S106 ◽  
Author(s):  
Aditya K. Gupta ◽  
Elizabeth A. Cooper
Keyword(s):  
Quality Of Life ◽  
Psoriatic Arthritis ◽  
Plaque Psoriasis ◽  
Large Scale ◽  
Severity Index ◽  
Biologic Therapies ◽  
Nail Psoriasis ◽  
Psoriatic Nail Disease

Nail psoriasis is common among patients with plaque psoriasis or psoriatic arthritis and has a detrimental effect on quality of life. However, there are currently no standardized therapeutic regimens for nail psoriasis. Traditional treatments for nail psoriasis, which include topical, intralesional, and oral therapies, may be time-consuming, painful, or unsafe when administered long term. Biologic therapies have demonstrated efficacy for plaque psoriasis and psoriatic arthritis; these therapies may be particularly promising for the treatment of nail psoriasis as both groups of patients have an elevated incidence of nail dystrophy. The biologic therapies adalimumab, alefacept, efalizumab, etanercept, and infliximab have demonstrated clinically important nail psoriasis improvements using the Nail Psoriasis Severity Index, a helpful tool that, upon validation, will allow comparison across treatments and trials. Large-scale, long-term trials using standardized outcome measures are needed to further evaluate biologic therapies for the treatment of nail psoriasis.

scholarly journals An Observational Study to Evaluate Quality of Life in Patients with Melasma in A Tertiary Level Hospital of Pokhara

2021 ◽  
Vol 19 (1) ◽  
pp. 37-41
Author(s):  
Prajwal Pudasaini ◽  
Saraswoti Neupane
Keyword(s):  
Quality Of Life ◽  
Age Of Onset ◽  
Life Quality ◽  
Sun Exposure ◽  
Severity Index ◽  
Cross Sectional ◽  
Medical College ◽  
The Mean ◽  
Hormonal Therapies

Introduction: Melasma is an acquired hyper melanosis that becomes more pronounced after sun exposure. Centro facial which is the commonest pattern followed by Malar and Mandibular are three clinical patterns of Melasma. Genetic influences, exposure to UV radiation, pregnancy, hormonal therapies, contribute to the pathogenesis of melasma. Melasma may considerably have significant effect on quality of life of patients.   Objectives: The present study was conducted to evaluate the effects of melasma in quality of life (QoL) in the form of DLQI (Dermatology Life Quality Index) and severity of melasma according to Melasma Area and Severity Index (MASI).   Materials and Methods: This is a hospital based cross-sectional prospective study conducted in 193 Melasma patients in the Department of Dermatology, Venereology and Leprology, Gandaki Medical College and Teaching Hospital, Pokhara from November 2018 to November 2019. MASI score was calculated and the patients were provided with a Nepali version of DLQI to fill up.   Results: This study included 193 patients. Mean age of patients with melasma was 29.4 ± 8.5 years with maximum reported age of 59 years. The Mean age of onset of disease was 26.5 years. The Mean age of onset of disease had little impact on DLQI. The mean DLQI score was 10.9 ± 5.9, thus indicating “very large effect on patient’s life”. The mean MASI score was 6.6 ± 5.2. It was found that there was no correlation between severity of disease and DLQI scores (p=0.317) Conclusion: Melasma commonly affected females during second and third decades of life. It had a very large effect on patient’s life as assessed by DLQI.    

scholarly journals Treatment with intralesional methotrexate injection in a patient with nail psoriasis

2022 ◽  
Vol 13 (1) ◽  
pp. 62-64
Author(s):  
Yesim Akpinar Kara
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Topical Treatment ◽  
Psoriasis Vulgaris ◽  
Corticosteroid Injection ◽  
Inflammatory Skin Disease ◽  
Nail Psoriasis ◽  
Nail Involvement ◽  
Systemic Therapies

Psoriasis vulgaris is an inflammatory skin disease involving the skin, nails, and joints. While nail involvement is observed in 70–80% of patients with psoriasis, the rate of patients with isolated nail involvement is 5–10%. Dystrophies arising in the nails in psoriasis affect the patient’s quality of life, and local and systemic therapies may be used as treatment. Intralesional methotrexate or corticosteroid injection might be an option in the treatment of patients with the involvement of one nail or some nails or without the involvement of the skin and joints, due to the side effects of systemic and biological agents. Herein, we report a female patient with nail psoriasis resistant to a previously applied topical treatment, the efficacy of intralesional methotrexate without the use of a systemic antipsoriatic agent, and no progression of side effects.

scholarly journals Treatments for Nail Psoriasis: A Systematic Review by the GRAPPA Nail Psoriasis Work Group

2014 ◽  
Vol 41 (11) ◽  
pp. 2306-2314 ◽  
Author(s):  
April W. Armstrong ◽  
William Tuong ◽  
Thorvardur J. Love ◽  
Sueli Carneiro ◽  
Rachel Grynszpan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Psoriatic Arthritis ◽  
Health Outcomes ◽  
Work Group ◽  
Treatment Recommendations ◽  
Systematic Analysis ◽  
Nail Psoriasis ◽  
Nail Involvement

Nail involvement in psoriatic diseases causes significant physical and functional disabilities. Evaluating, measuring, and treating nail involvement is important in improving the health outcomes and quality of life among patients with psoriasis and psoriatic arthritis (PsA). We performed a systematic analysis of the literature on nail psoriasis to help inform an update of treatment recommendations by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).

scholarly journals POS1072 ASSOCIATION OF NAIL PSORIASIS WITH WORSE DISEASE OUTCOMES IN PSORIATIC ARTHRITIS PATIENTS. DATA FROM CLINICAL PRACTICE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 815.2-815
Author(s):  
E. Gubar ◽  
Y. Korsakova ◽  
E. Loginova ◽  
S. Glukhova ◽  
T. Korotaeva ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Practice ◽  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Severe Disease ◽  
Work Productivity ◽  
Disease Status ◽  
Nail Psoriasis ◽  
Nail Involvement

Background:Limited data are available regarding the burden of nail disease in psoriatic arthritis (PsA). The latest data show that nail involvement in PsA patients (pts) is associated with significantly more severe disease status (1).Objectives:To analyze, in clinical practice, the association of nail psoriasis with disease activity, quality of life, and work productivity in PsA pts.Methods:588 pts (M/F–277 /311) with PsA according to CASPAR criteria were included in the study. Data were collected from 43 rheumatology clinics from different regions of the Russian Federation. Pts’ age 48.6±0.5 years (yrs), disease duration 7.0±0.3 yrs. Pts underwent standard clinical examination of PsA activity. Pts were split into two groups (gr.): those with nail psoriasis – gr.1, and those without it – gr.2. Demographics, disease activity, quality of life, and work productivity were compared between pts with and without nail psoriasis using Pearson’s chi-square test and Mann–Whitney U test.Results:Gr.1 includes 312 (53.1%) cases, gr.2 – 276 (46.9%) cases. More pts in gr.1 were males (51.9% vs 44.1%, р=0.013), disabled at work (37.20% vs 26.40%, р=0.000), chronic smokers (18.9% vs 8.7%, р=0.000) and with axial PsA disease signs according to physician (35.0% vs 26.4%, р=0.025) compared to pts in gr.2. Pts in gr.1 had higher tender and swollen joint counts: 8 [4-15] vs 5 [2-12] (р=0.002) and 5 [1-9] vs 2 [0-7] (р=0.003) respectively. Gr.1 pts had higher disease activity measured by DAPSA 25 [15-39] vs 20 [12-33] (p= 0.001), higher frequency of dactylitis (24.4% vs 16.7% р=0.022) and heel enthesitis (17.0% vs 10.1% р=0.016) respectively, higher frequency of erosive radiographic arthritis of feet (45.0% vs 31.2% р=0.003) compared to gr.2 pts. Pts in gr.1 had worse skin psoriasis measured by Psoriasis Area Severity Index – 6 [2-14] vs 3 [1-6] (р=0.000). Less pts in gr.1 than in gr.2 (27.0% vs 52.0% р=0.004) achieved minimal disease activity (MDA). Pts’ reported outcomes (PRO’s) in gr.1 were worse than in gr.2 in regard to reduced health-related quality of life according to PsAID (4.9±2.3 vs 4.0±2.3, р=0.040) and to EQ-5D (0.56±0.19 vs 0.64 ±0.21, р=0.024) questionnaires, overall work impairment (0.0 [0.0-0.3] vs 0.0 [0.0-0.2], р=0.034) and overall activity impairment (0.4 [0.1-0.7] vs 0.3 [0.0-0.5], р=0.006) according to WPAI.Conclusion:Nail involvement in PsA pts is associated with male gender and axial disease. PsA pts with nail involvement are more often disabled, more often are chronic smokers, have significantly worse disease status as measured by disease activity; they are more likely to have more severe (erosive) peripheral arthritis of feet, higher frequency of heel enthesitis and dactylitis, higher psoriasis disease severity, lower frequency of MDA achievement, and worse quality of life and work productivity according to PRO’s. Detection of nail involvement is critical for choice of treatment approach and better outcomes.References:[1]Mease PJ et al.J Rheumatol, 2020Disclosure of Interests:None declared.

scholarly journals The Impact of Nail Psoriasis and Treatment on Quality of Life: A Systematic Review

2021 ◽  
pp. 1-7
Author(s):  
Claire R. Stewart ◽  
Leah Algu ◽  
Rakhshan Kamran ◽  
Cameron F. Leveille ◽  
Khizar Abid ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Nail Psoriasis ◽  
Percent Improvement ◽  
Patient Reported ◽  
The Impact ◽  
Nail Involvement

At least 80% of patients with psoriasis will have nail involvement during their lifetimes. Understanding quality of life (QoL) impact of this condition and associated treatments is of utmost importance. Study objectives were to review the available literature describing patient-reported QoL outcomes in nail psoriasis and relationship with disease severity and treatment. A literature search was performed for English-language articles published prior to August 1, 2020. Articles were included in the review if primary data and validated patient-reported outcome measures assessing QoL were presented, and nail involvement was specifically examined. Fifteen studies were included in the final analysis. Patients with nail psoriasis had higher Psoriasis Area Severity Index and Dermatology Life Quality Index scores than those with psoriasis without nail involvement. The largest percent improvement in QoL score was associated with adalimumab. Studies investigating topicals, intralesionals, and systemic treatments were excluded since only biologic studies utilized validated patient-reported outcome measures. This review affirms that nail psoriasis is physically and emotionally distressing, warranting prompt treatment. Increased efforts are needed to address the impact of treatment on patient QoL using validated outcome measures that assess cosmetic, physical, and social problems.

Nagelpsoriasis: Anti-IL17-Therapie ist erfolgversprechend

2020 ◽  
Vol 8 (3) ◽  
pp. 111-113
Author(s):  
Sandra Philipp
Keyword(s):  
Quality Of Life ◽  
Severity Index ◽  
Primary Objective ◽  
Controlled Study ◽  
Upper Respiratory Tract ◽  
Double Blind ◽  
Nail Psoriasis ◽  
Patient Questionnaires ◽  
Tract Infections

Background: Nail psoriasis is associated with functional impairment, pain and reduced quality of life. Objectives: To demonstrate the superiority of secukinumab over placebo in clearing nail psoriasis as assessed by the Nail Psoriasis Severity Index (NAPSI) at week 16 and over time up to week 132. Presented here is the week 32 interim analysis. Impact on quality of life was assessed by Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA) patient questionnaires. Methods: TRANSFIGURE is a double-blind, randomized, placebo-controlled study in patients with moderate-to-severe plaque and nail psoriasis. Results: The primary objective of this study was met: both doses of secukinumab were superior to placebo at week 16 (NAPSI improvements of -45,3%, -37,9% and -10,8% for secukinumab 300 mg and 150 mg and placebo, respectively, P<0,001). Significant improvements were seen in patients’ quality of life: the NAPPA-Quality of Life total score median decreases at week 16 were 60,9%, 49,9% and 15,8% for secukinumab 300 mg and 150 mg and placebo, respectively (P < 0_001). Improvement in nail psoriasis continued to week 32: NAPSI percentage change reached -63,2% and -52,6% for secukinumab 300 mg and 150 mg, respectively. Skin clearance measured by ≥90% improvement in Psoriasis. Area and Severity Index was significant (rates of 72,5%, 54,0% and 1,7% for secukinumab 300mg and 150mg and placebo at week 16, respectively, P<0,001) and was sustained to week 32. The most common adverse events were nasopharyngitis, headache and upper respiratory tract infections. Conclusion: Secukinumab demonstrated significant and clinically meaningful efficacy and quality-of-life improvements for patients with nail psoriasis up to week 32.

Nail Changes in Psoriasis: Correlation Between Onychoscopy and NAPSI Scoring

2021 ◽  
pp. 247553032110114
Author(s):  
Anisha P. Bindagi ◽  
Bhavana Doshi ◽  
Ashok Pandit ◽  
Basavapudda Manjunathswamy
Keyword(s):  
Severity Index ◽  
Cross Sectional Study ◽  
Control Group ◽  
Diagnostic Challenge ◽  
Psoriasis Area Severity Index ◽  
Cross Sectional ◽  
Nail Psoriasis ◽  
Nail Changes ◽  
One Year ◽  
Nail Involvement

Background: Nail changes in psoriasis can present as a diagnostic challenge especially in the absence of cutaneous features. They occur in approximately 40% of psoriatics and in 5% as the sole presentation. Onychoscopy as a diagnostic tool aids in better visualization of nail matrix and bed abnormalities in psoriasis patients with nail involvement. Aim: To study onychoscopic features of nails in psoriasis and correlate it clinically using nail psoriasis severity index (NAPSI). Materials and Methods: A total of 60 patients of psoriasis with nail changes were recruited in this hospital based cross-sectional study over a period of one year. Cutaneous severity was assessed using psoriasis area severity index (PASI). NAPSI was used to determine the severity of nail involvement. Nails of the patients with psoriasis were examined clinically and onychoscopically. Statistical analysis was done using the software R i386.3.6.3. Results: Pitting was the most common nail change observed on clinical and onychoscopic examination, seen in 90% and 95% patients respectively. Leuconychia, red spots in lunula, onycholysis, and splinter hemorrhages were better visualized on onychoscopy. A statistically significant higher NAPSI (P < 0.05) was obtained on onychoscopy. There was a positive co- relation between the cutaneous severity of psoriasis and the extent of nail involvement. Conclusion: Onychoscopic examination coupled with NAPSI in nail psoriasis serves as a useful guide to assess the nail involvement and provides a better insight into the subtle nail changes in psoriatics which could have been missed clinically. Limitations: Small study population, lack of age and sex matched control group.

Sign in / Sign up

Export Citation Format

Share Document