Nail psoriasis in China

[Fred]

A prospective multicentre study of nail psoriasis in China. 

Quote:

---

Background:
Data on nail psoriasis (PsO) in China are scarce.

Objectives:
To provide nail PsO-related data regarding epidemiologic characteristics, manifestations, fungal infections, arthritic complaints and treatments that may facilitate improved patient management globally.

Methods:
From August 2021 to August 2022, patients with nail PsO were enrolled in a prospective multicentre observational study at 25 hospitals in China. We collected and analysed data concerning nail PsO demography, clinical signs, fungal detection, arthritic symptoms and treatment.

Results:
A total of 817 patients with nail PsO were involved, with a mean body mass index of 24.13 ± 2.93. In addition, 71.41% of the patients were male. The Nail PsO Severity Index score was weakly positively correlated with body surface area. The percentage of nail involvement was 95.29% for fingernails and 57.18% for toenails, with pitting (67.11%) and subungual hyperkeratosis (60.40%) being the most prevalent manifestations, respectively. Toenails showed a significantly higher frequency of nailfold scales, subungual hyperkeratosis and nail plate crumbling and a lower frequency of splinter haemorrhages, pitting and erythema of the lunula. A total of 13.26% of the PsO patients had onychomycosis, and 77.08% were observed in the toenails. Articular symptoms were reported by 12.17% of the patients, with the peripheral type being predominant. Significant associations between articular symptoms and nailfold swelling, subungual hyperkeratosis, nailfold scales, onycholysis and longitudinal ridges were found. Only 2.30% (20 out of 871) of patients with nail PsO received treatment. The most frequently employed therapy for cutaneous PsO with nail involvement was biologic therapy (n = 366).

Conclusions:
PsO showed distinct manifestations in the toenails and fingernails. Additionally, toenail PsO combined with onychomycosis requires special attention. Articular symptoms in psoriatic patients are associated with specific nail changes. It is important to research and advocate for more potent treatments for nail PsO.

Source: onlinelibrary.wiley.com

*Funding: National Key & D Program of China

[Caroline]

As far as I know, nail psoriasis AND joint problems are an important diagnostic tool for determining if the disease is really Psoriatic Arthritis.

This studie does say you should treat the nail Psoriasis, but does not say anything about the result on Psoriatic Arthritis after the treatment.

By the way, because this is a Chinese study, I recently found out that Asian people very much more often have GPP, General Pustular Psoriasis, then people from Europe or the US.

[Fred]

My dermatologist has always said that the nails are a giveaway for psoriasis but more so with psoriatic arthritis. She said she can tell a lot from the nails and it depends on the pits or lines and also lifting or yellowness.

[Kat]

My daughter is having nail issues. They split and crack but they are not thickened. I've told her she needs to have them looked at so hopefully she'll do that soon. It made me wonder if there was something "more" going on with her (not necessarily psoriasis related but possibly)

[Raxyl]

I have one abnormal nail on my left hand as well as plaques and deep cracking around the first knuckle despite secukinumab, I'm currently treating it with a steroid ointment however it is quite persistant.