Nail Involvement as a Predictor of Disease Severity in Paediatric Psoriasis: Follow-up Data from the Dutch ChildCAPTURE Registry

Abstract

Little is known about the relationship between nail psoriasis and psoriasis severity in children, and there has been no longitudinal assessment of psoriasis severity related to nail psoriasis. The aim of this study was to assess whether nail psoriasis could serve as a predictor for a more severe disease course. De-identified data were obtained from the Child-CAPTURE registry, a daily clinical practice cohort of children with psoriasis, from September 2008 to November 2015. Cross-sectional analyses were performed at baseline. Longitudinal data until 2-year follow-up were analysed by linear mixed models. Nail psoriasis was present in 19.0% of all 343 patients at baseline and cross-sectionally associated with higher Psoriasis Area and Severity Index (PASI) (p = 0.033). Longitudinal analysis demonstrated higher PASI (p < 0.001) during 2-year follow-up in patients with nail involvement at baseline. These findings suggest that nail psoriasis is a potential clinical predictor for more severe disease course over time in paediatric psoriasis.

Efficacy of ixekizumab on nail psoriasis in paediatric patients with moderate‐to‐severe psoriasis: a post hoc analysis from IXORA‐PEDS

“…Consistent with previously published studies, 2 , 6 in IXORA‐PEDS, patients with NP were mostly male and had more severe skin disease, including involvement of other difficult‐to‐treat areas such as palmoplantar and scalp psoriasis (Table 1 ). Of note, only one patient with significant baseline NP had concomitant psoriatic arthritis.…”

“…Patients were stratified based on fingernail involvement (fingernail NAPSI range: 0-80) as having any degree of NP ('baseline NP', N = 34), defined as fingernail NAPSI ≥1, and from that, the subgroup of patients with moderate-to-severe NP ('significant baseline NP', n = 20/34) defined as fingernail NAPSI ≥16 and ≥4 fingernails involved. 5 Consistent with previously published studies, 2,6 in IXORA-PEDS, patients with NP were mostly male and had more severe skin disease, including involvement of other difficult-to-treat areas such as palmoplantar and scalp psoriasis (Table 1). Of note, only one patient with significant baseline NP had concomitant psoriatic arthritis.…”

“…Efficacy of ixekizumab on nail psoriasis in paediatric patients with moderate-to-severe psoriasis: a post hoc analysis from IXORA-PEDS Dear Editor, Nail psoriasis (NP) has been proposed as a potential clinical predictor for a more severe disease course in children with psoriasis, but data regarding NP in children are scarce. [1][2][3] Ixekizumab (IXE), a high-affinity monoclonal antibody that selectively targets interleukin(IL)-17A, is an EMA and FDA approved treatment for paediatric (≥6 years old) and adult patients with moderate-to-severe psoriasis and provides rapid clinically meaningful improvements in skin, itch and quality of life (QoL) outcomes at week 12. 3,4 In IXORA-PEDS, a phase III multicentre, double-blind, randomized, placebo-controlled study (NCT03073200), which assessed efficacy and safety of IXE in paediatric patients with moderate-to-severe psoriasis, 3 50% of patients randomized to IXE at baseline achieved complete clearance (Nail Psoriasis Severity Index [NAPSI] score = 0) in their NP by week 48.…”

Skin Surface Protein Detection by Transdermal Analysis Patches in Pediatric Psoriasis

“…In daily clinical psoriasis care, more guidance regarding treatment response and disease course is desirable. Predictors for disease course are scarce and mainly include clinical patient characteristics (e.g., nail psoriasis and psoriatic arthritis) [1,2]. Research focusing on prediction of treatment success in psoriasis mainly targets the body mass index, genotyping, human leukocyte antigen typing, or blood-derived systemic inflammation markers [3][4][5][6][7].…”

Imaging of the nail unit in psoriatic patients:A systematic scoping review of techniques and terminology

“…Nail involvement among psoriatic patients is common, with reported prevalence rates of 10%–82% and an estimated lifetime incidence of >80% 1 . Psoriatic nail disease (PND) without skin involvement is present in 5%–10% of psoriatic patients, considered a prognostic factor for the development of psoriatic arthritis (PsA) 2 and disease severity in cutaneous psoriasis, 3 and associated with greater reduction in quality of life (QoL) 4 . Diagnosis of and treatment recommendations for PND are mainly based on clinical evaluation, often involving one of several clinical scoring systems 5 .…”