Shikha Khare1, Sudha Agrawal2
BACKGROUND
Nail involvement in psoriasis is likely to influence the quality of life (QOL) because
of its highly visible site; however, the impact of this disease on QOL is an
underexplored area. Similarly, the relationship between severity of skin
involvement and nail involvement has been overlooked. The study was conducted
to evaluate the clinico-epidemiological characteristics of psoriasis patients with and
without nail changes and assess the health-related quality of life (HRQOL).
Furthermore, the correlation of severity of nail involvement with the severity of
skin involvement and its impact on quality of life was assessed.
METHODS
A total of 370 adult psoriasis patients with or without nail changes was studied.
Skin severity was assessed by body surface area (BSA) and Psoriasis Area and
Severity Index (PASI) while nail severity was assessed using Nail Psoriasis Severity
Index (NAPSI). Patients’ quality of life was measured using the Nepali Version of
Dermatology Life Quality Index (DLQI).
RESULTS
Nail psoriasis was more prevalent in males in both the groups; females were
having more nail involvement (0.041). There were no significant diff erences in
other clinico-epidemiologic characteristics between these two groups except the
late onset of psoriasis in the age group > 30 years, scalp involvement and absence
of family history of psoriasis (P ≤ 0.05). There was a strong positive correlation
between the age of onset of skin changes with age of onset of nail involvement (r
= 0.799) and the joint involvement (r = 0.742) as well as the age of onset of joint
involvement with nail changes (r = 0.838). The mean PASI was 7.265 ± 7.153 vs.
6.189 ± 7.153 in patients with > 10 vs. ≤ 10 total NAPSI score and it was
statistically significant (P = 0.011), however, there was a moderate positive
correlation between PASI and NAPSI (r = 0.32). Almost half of psoriasis patients
had very large to extremely large effects on quality of life but leisure and treatment
domain were affected more amongst patients with nail changes. Early onset of
joint involvement, body surface area of > 3 % involvement and PASI score > 5
had significant effect on quality of life.
CONCLUSIONS
The nail involvement is an important finding in determining the severity of skin
involvement and had very large to extremely large effect on quality of life
particular on leisure and treatment domain. Therefore, nail examination must be
done in all psoriatic patients.
