A dermoscopic study of nail involvement in chronic plaque psoriasis at a tertiary care center

Abstract

Background: Psoriasis is a chronic inflammatory disease that affects millions of people throughout the world. Nail involvement is a common feature in psoriasis which is often overlooked despite causing significant functional impairment, disfigurement, and psychological stress to the patient. Dermoscopy is a non-invasive novel tool that enables a rapid and magnified visualization of the nail changes which are often imperceptible to the unaided eye. Aims and Objectives: To study the dermoscopic profile of nail changes in patients with chronic plaque psoriasis. Materials and Methods: The study was conducted from December 2018 to May 2020, in the Department of Dermatology of a tertiary care center in Kerala, including 155 patients of clinically diagnosed chronic plaque psoriasis who had nail involvement. A detailed history was noted along with a clinical and dermoscopic examination of all 20 nails of each patient. Results: The most common finding on dermoscopic examination of the nails was onycholysis seen in 91%, followed by pitting (78.8%) and subungual hyperkeratosis (78.1%). Other findings noted in our study which are not commonly described are wavy lamellar microsplitting (41.9%), cuticular hypertrophy (18.1%), pseudofiber sign (16.1%), dilated nailfold capillaries (12.3%), capillary prominence at onychodermal band (7.7%), dilated hyponychial capillaries (7.7%), and fuzzy lunula (7.1%). Conclusion: Nails are frequently involved in psoriasis but often overlooked. Dermoscope is an effective tool that facilitates the assessment of nail changes in psoriasis.

Matching between clinical examination and dermoscopy in patients with nail psoriasis: Should dermoscopy be used instead of clinical examination?

“…Furthermore, the resemblance between clinical examination and digital dermoscopy in diagnosing nail psoriasis complications, according to NAPSI, considerably implies the role of dermoscopy in assessing NAPSI compared to the clinical assessment due to its sensitivity for more accurate findings of nail psoriasis complications [ 22 ]. Therefore, except for histopathology, dermoscopy may be the future gold-standard diagnostic tool for nail psoriasis [ 14 , [23] , [24] , [25] ]. In addition, positive associations between several dermoscopic manifestations and disease severity were reported [ 22 , 26 ].…”