Incidence, clinical manifestations and clipping of nail psoriasis in the dermatology center of the Hospital Universitário Evangélico de Curitiba

Abstract

BackgroundPsoriasis is a chronic inflammatory skin disease that often progresses with nail alterations. It is suspected that there is a correlation between nail psoriasis and enthesitis of the distal interphalangeal joint, seeming to serve as a predictor.ObjectivesTo analyze the profile of patients with nail psoriasis and correlate the presence of nail alterations with psoriatic arthritis, quality of life, extent of psoriasis and the histopathology of the nail.MethodsAn observational cross-sectional study with 40 patients with a diagnosis of psoriasis and without systemic treatment. The patient profile was researched, including quality of life and evaluated for the presence of psoriatic arthritis. The severity of the skin psoriasis and the presence of nail lesions were evaluated. Nail fragments were collected and analyzed through clipping. It obtained 100% of positivity for psoriasis in the histopathology exam of the nail plate.ResultsOf the 40 patients, 65% were diagnosed with nail psoriasis. Suggestive findings of psoriatic arthritis in hands were present in 33%, being more frequent in those with nail alteration (p = 0.01). In 92.3% of patients diagnosed with psoriatic arthritis in the hands there was some nail injury. The most frequent injuries were pitting and onycholysis.ConclusionsPatients with nail psoriasis are usually men, with worse quality of life and higher chance of psoriatic arthritis. The correlation between the nail involvement of psoriasis and psoriatic arthritis in hands confirms the association between these two forms. The clinical diagnosis of nail psoriasis did not correlate with the histological diagnosis.

Prevalence of onychomycosis among patients with nail psoriasis who are not receiving immunosuppressive agents: Results of a pilot study

“…This finding can perhaps be explained through the observation that psoriasis patients with nail lesions tend to have higher DLQI scores compared to those without . The score was also found comparable to that calculated in a few other studies, including 3 studies assessing biologic agents (these patients have more severe disease by default) . Finally, it was found lower than the mean DLQI score of patients participating in other biologic agent‐assessing studies .…”

Clinical and histological spectrum of nail psoriasis: A cross‐sectional study

“…Recently, the use of nail clipping microscopy as a diagnostic tool for nail psoriasis has also been studied . Although there are many studies delineating the clinical features of nail psoriasis, very few have described the histopathological features, or tried to correlate the two.…”

“…[8][9][10][11] Recently, the use of nail clipping microscopy as a diagnostic tool for nail psoriasis has also been studied. [12][13][14][15] Although there are many studies delineating the clinical features of nail psoriasis, very few have described the histopathological features, or tried to correlate the two. In an attempt to bridge this gap, this descriptive cross-sectional study was undertaken to study the histopathological features of nail psoriasis.…”

“…Comparative table with frequency of histopathological features8,9,12,14,15 PAS stain refers to the periodic acid-Schiff stain performed on tissue specimen to evaluate the presence of fungal elements. In the studies included here, both H&E and PAS stain were performed in all cases with two exceptions: Uber et al used only PAS stain with diastase in their study and Hanno et al stained only with H&E. The percentage of positive cases indicates the number of cases with presence of either hyphae, yeast forms or spores in the nail tissue.…”

Nail psoriasis – what a rheumatologist should know about

“…As the fingernails grow 0.1 mm/day, psoriatic nail lesions can be troublesome over a long time. Nail psoriasis, psoriatic lesions in the gluteal cleft and on the scalp usually accompany PsA, especially in adult men [5, 6]. About 50% of patients with nail psoriasis complain of pain, stiffness or swelling of the interphalangeal joint in the absence of a diagnosis of arthropathy, which could suggest the early stage of PsA [7].…”