Nail Psoriasis Severity Index

NewsBot · Feb 13, 2008

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The comparison of Nail Psoriasis Severity Index with a less time-consuming qualitative system
Kaçar, N; Ergin, Ş; Erdogˇan, BŞ
Journal of the European Academy of Dermatology & Venereology, Volume 22, Number 2, February 2008 , pp. 219-222(4)

Reliable assessment of severity in nail psoriasis is essential to document treatment responses in clinical trials and routine clinical usage. In this study the correlation between Nail Psoriasis Severity Index (NAPSI) and Cannavo's scoring system was assessed, and inter-rater correlation of NAPSI scores were evaluated.

Materials and Methods
Forty-five patients with nail psoriasis were included. Target nails were selected and graded by the first dermatologist with both scoring systems. The nails were reevaluated by the second dermatologist with NAPSI.

Results
The two systems were highly correlated (P < 0.001). For NAPSI inter-rater correlation was also significant (P < 0.001).

Conclusion
Our results showed that the qualitative and quantitative evaluations of the same rater were similar. Although the qualitative scoring system of Cannavo's is less time consuming than NAPSI, to suggest this system inter-rater correlations should be evaluated.
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Admin2 · Feb 13, 2008

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NewsBot · Apr 13, 2013

Nail Psoriasis: a questionnaire-based survey
K.M.G. Klaassen, P.C.M. van de Kerkhof, M.C. Pasch
British Journal of Dermatology; Accepted Article

Background
Skin manifestations are the most characteristic finding of psoriasis. However, nail involvement is also a clinical feature of disease although it is often overlooked. The documented prevalence of nail psoriasis varies between 10.0 and 81.1%.

Objective
The aim of this investigation was to gain knowledge about the prevalence and clinical manifestations of nail psoriasis and patient experiences on treatment of nail psoriasis.

Method
A structured self-administered questionnaire was distributed to all members (n=5400) of the Dutch Psoriasis Association. The questionnaire enquired about socio-demographic patient characteristics, disease-related data and treatment of nail psoriasis. Patients reported their nail manifestations after instruction with photographs. Patients with nail psoriasis were compared to patients without nail psoriasis.

Results
A response rate of 27% was achieved. The prevalence of nail psoriasis was 66.0%. The most frequently observed psoriatic nail manifestation was pitting (65.4%), whereas red spots in the lunula were infrequently seen (6.5%). Patients with nail psoriasis more frequently stated psoriasis capitis (75.8 vs 65.7%), genital psoriasis (32.7 vs 20.3) and psoriatic arthritis (46.4 vs 30.6) compared to psoriatic patients without nail involvement. Only 16.0% of patients received treatment for nail psoriasis. Systemic therapies were most frequently stated as effective for nail lesions.

Conclusion
Nail manifestations seems to be more prevalent in psoriatic patients than previously thought. In addition, nail psoriasis shows to be associated with widespread and more severe forms of psoriasis and different treatment options are experienced as effective for nail psoriasis. Notwithstanding, nail psoriasis is still an often overlooked feature of the disease.
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NewsBot · Mar 11, 2015

Treatment of nail psoriasis: best practice recommendations from the Medical Board of the National Psoriasis Foundation.
Crowley JJ, Weinberg JM, Wu JJ, Robertson AD, Van Voorhees AS
JAMA Dermatol. 2015 Jan;151(1):87-94

IMPORTANCE:
Nail psoriasis can be difficult to treat and has a significant effect on quality of life. Relatively few controlled trials evaluating treatments for nail psoriasis have been published. There is an unmet need for treatment recommendations to guide therapeutic decisions.
OBJECTIVE:
To develop treatment recommendations for nail psoriasis from the Medical Board of the National Psoriasis Foundation.
EVIDENCE REVIEW:
A PubMed search for publications on nail psoriasis treatments was performed from January 1, 1947, through May 11, 2014, without language restrictions.
FINDINGS:
Treatment recommendations for 4 clinical nail psoriasis scenarios were developed based on the evidence reviewed in this study and expert opinion of the Medical Board of the National Psoriasis Foundation. Treatment of nail psoriasis should balance consideration of the extent of skin disease, psoriatic arthritis, and severity of nail disease with concomitant impairment of quality of life. All patients should be evaluated for onychomycosis because this may complicate psoriatic nail disease. For disease limited to the nails, high-potency topical corticosteroids with or without calcipotriol are initial options. For patients with significant nail disease for whom topical therapy has failed, treatment with adalimumab, etanercept, intralesional corticosteroids, ustekinumab, methotrexate sodium, and acitretin are recommended. For patients with significant skin and nail disease, adalimumab, etanercept, and ustekinumab are strongly recommended, and methotrexate, acitretin, infliximab, and apremilast are recommended. Finally, for a patient with significant nail, skin, and joint disease, adalimumab, etanercept, ustekinumab, infliximab, methotrexate, apremilast, and golimumab are recommended.
CONCLUSIONS AND RELEVANCE:
Treatment of nail psoriasis poses a clinical challenge. Clinical trial data are limited, and results are reported inconsistently, making comparisons among treatment options difficult. The treatment recommendations from the Medical Board of the National Psoriasis Foundation will help guide treatment decisions for clinicians who are treating patients with nail psoriasis.
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NewsBot · Oct 6, 2015

Nail psoriasis: An updated review of clinical reports on therapy and formulation aspects for topical delivery
Monica Joshi, Vijay Sharma, Kamla Pathak,
Journal of Drug Delivery Science and Technology; 30 September 2015

The treatment of the psoriatic nails is strenuous and systemic therapies are associated with various side effects that lead to patient incompliance. Topical therapy seems to be mainstay approach that limits side effects and is patient compliant. The topical formulations include creams, gels, and ointments and nail lacquers. Of these nail lacquers appear to be promising, patient friendly formulation. However, the major challenge through topical route is inefficient permeation of drug through dense keratinized nail plate to reach target sites: nail matrix and nail bed. Chemical and physical enhancement techniques can be used for enhancing the drug permeation through nail plate. There has been quite a lot of research in this field in recent times. The current review focuses on various clinical reports on systemic, topical and peripheral therapies (intralesional, phototherapy and laser). It primarily focuses on topical nail lacquer formulation wherein an attempt has been made to summarize the factors affecting permeation of drug across the nail plate. Further, physical and chemical modes for permeation enhancement have been described. Finally the medicated nail lacquers as an effective and novel drug delivery system for treating nail psoriasis has been reviewed
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NewsBot · Oct 6, 2015

Nail psoriasis: An updated review of clinical reports on therapy and formulation aspects for topical delivery
Monica Joshi, Vijay Sharma, Kamla Pathak,
Journal of Drug Delivery Science and Technology; 30 September 2015

The treatment of the psoriatic nails is strenuous and systemic therapies are associated with various side effects that lead to patient incompliance. Topical therapy seems to be mainstay approach that limits side effects and is patient compliant. The topical formulations include creams, gels, and ointments and nail lacquers. Of these nail lacquers appear to be promising, patient friendly formulation. However, the major challenge through topical route is inefficient permeation of drug through dense keratinized nail plate to reach target sites: nail matrix and nail bed. Chemical and physical enhancement techniques can be used for enhancing the drug permeation through nail plate. There has been quite a lot of research in this field in recent times. The current review focuses on various clinical reports on systemic, topical and peripheral therapies (intralesional, phototherapy and laser). It primarily focuses on topical nail lacquer formulation wherein an attempt has been made to summarize the factors affecting permeation of drug across the nail plate. Further, physical and chemical modes for permeation enhancement have been described. Finally the medicated nail lacquers as an effective and novel drug delivery system for treating nail psoriasis has been reviewed
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NewsBot · Mar 30, 2018

Reporting of outcomes in randomized controlled trials on nail psoriasis: a systematic review
C.I. Busard J.Y.C. Nolte M.C. Pasch P.I. Spuls
British Journal of Dermatology, 178, 640–649, March 2018

One of the important complications of the skin disease, psoriasis, is the appearance of changes in the nails. These range from the formation of small pits across the surface of the nail to painful separation of the nail plate from the underlying nail bed and disfiguring enlargement and thickening of the nail itself. Given this wide range of changes in appearance it is important that, in assessing the results of treatment, researchers can use simple, but accurate, criteria for measuring changes in psoriatic nails under treatment; these are known as core outcome sets. This study, organised by investigators from the departments of dermatology in the Universities of Amsterdam and Nijmegen in the Netherlands, surveyed 65 clinical trials focussing on nail psoriasis, all of which used assessment measures for nail changes in psoriasis, the commonest of which is called the nail psoriasis severity index. However, they found that several different methods were used in the various studies. A detailed analysis of these studies has identified a number of variations in the methods used which make the results of different treatments difficult to compare. This is particularly because there was no standard way of expressing the final scores of the severity of nail disease found in these studies and also that the different aspects of severity were rated differently. Some of these assessment scoring systems have not been validated (substantiated) either. The authors call for a rethink of the use of nail assessments in psoriasis and highlight the need to develop new methods which are sufficiently robust to stand up to close scrutiny. These should allow investigators to assess the different changes seen in the diseased nails in a standardised way, so that results of different studies can be compared. They suggest that a consensus group should be established to carry out this work.
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NewsBot · Sep 18, 2019

Efficacy of long pulsed ND-yag laser in the treatment of nail psoriasis: A clinical and dermoscopic evaluation
SA Khashaba et al
Journal of Dermatological Treatment : 16 Sep 2019

Background: Nail psoriasis is frequently seen in psoriatic patients. It is difficult to treat and shows unsatisfactory response to topical preparations. Recently, different types of Lasers have been shown to be effective in some nail disorders. Aim: The aim was to evaluate the efficacy and safety of long pulsed Nd: YAG laser 1,064 nm as a method for nail psoriasis treatment. Methods: A prospective intra-patient left-to-right, randomized, placebo-controlled study conducted on twenty-two patients with bilateral fingernail psoriasis, randomly assigned into right or left-side therapy with either 4 sessions of long pulsed Nd:YAG laser once monthly or daily topical placebo for 4 months, followed by 3 months follow up. Evaluation was done using nail psoriasis severity index at baseline, 2nd month, 4th month and after follow up period. Clinical and dermoscopic photographs were taken both at baseline and at 4th month. Results: There was a statistical significant improvement in both nail psoriasis severity index and dermoscopic features in laser side, along with significant difference between laser and placebo side. Nail bed showed obvious improvement than nail matrix. Conclusion: Nd:YAG laser represents an effective and safe modality for nail psoriasis treatment and dermoscopy is a useful tool for treatment efficacy assessment.
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