Nail Changes in Childhood Psoriasis: A Study from Kuwait

Abstract

Psoriasis is a widespread skin disorder in which nail involvement can be seen in up to two-thirds of those affected. Childhood psoriasis is a distinct entity and the literature focused on nail changes associated with childhood psoriasis is scant. Our objectives were to evaluate the frequency of nail involvement in childhood psoriatic patients, assess the types of nail changes in childhood psoriasis, and compare our clinical findings with the few reports available in the literature. Two hundred and one consecutive new patients with childhood (age < or = 16 years) psoriasis of both sexes were selected for the study of nail changes. The diagnosis of psoriasis was made on clinical grounds. Each patient underwent a thorough dermatologic examination with special attention paid to the nail changes. If a clinical suspicion of fungal infection of the nails existed, further mycologic investigations were performed. We found the prevalence of nail changes to be 37.81% (boys > girls) in children who had psoriasis. Nail pitting was found to be the most common manifestation (61.84%) followed by onycholysis (30.26%), subungual hyperkeratosis (13.16%), and discoloration of the nail plate (7.90%). Nail involvement had no relationship to the type of psoriasis, patient's sex, or duration or extent of disease.

Detailed Analysis of Specific Nail Psoriasis Features and Their Correlations with Clinical Parameters: A Cross-Sectional Study

“…The major distinguishing result was the presence of nail psoriasis in almost 67% of patients (F = 152/228). The majority of the researchers have reported that the frequency of nail involvement in psoriatic patients is about 75–83% [2,6,7,8,16], although there are reports asserting that it is between 10 and 55% [1,3,4,5,9,11]. Moreover, there are reports mentioning that 80–90% of the psoriatic patients will develop nail psoriasis at some point of their lives [1,9,11,12].…”

“…On the other hand, there are reports assessing that subungual hyperkeratosis is the most common psoriatic nail feature [1,7]; Grover et al [3] found out that onycholysis is the most repeated psoriatic nail feature. In childhood psoriasis, pitting was evaluated to be the most common psoriatic nail feature [16], whereas discoloration was the one in patients suffering from psoriatic arthritis [13]. …”

Nail Psoriasis in Children: Common or Uncommon Results from a 10-Year Double-Center Study

“…Histological confirmation was provided only in doubtful cases, but whether nail biopsies were performed was not specified. In one of the largest studies by Tollefson et al [1] , biopsies were obtained only in 14% of the psoriasis cases, while in our study as well as in that by AlMutairi et al [3] , focusing solely on nail psoriasis, the diagnosis was exclusively clinical.…”

“…In our experience, onycholysis with erythematous border, trachyonychia and nail plate crumbling were the other possible presentations of psoriasis in the nails. The only study applying the KOH examination to rule out fungal infection of the nail was that by Al-Mutairi et al [3] . In our experience, mycology was necessary only in nail psoriasis limited to the toenails when the symptoms were onycholysis and subungual hyperkeratosis and found in children with psoriasis of a single fingernail with diffuse nail plate crumbling.…”

“…In children, the prevalence of psoriasis is 0.71% in Europe and is increasing throughout the years [2] . Epidemiological studies reveal that in 37% of the adult patients, psoriasis appears by the age of 20, in 27% by the age of 15, in 10% by the age of 10 and in 2% by the age of 2 [3][4][5] . An earlier onset heralds a graver prognosis as well as higher familial occurrence [6] .…”