Abstract

 
BACKGROUND:
Nail psoriasis occurs in both adults and children. Nail involvement is associated with significant physical and psychological consequences for a substantial number of patients. The prevalence of nail changes among patients with psoriasis varies between 10 and 55 percent. In most patients, nail involvement follows or is concurrent with onset of cutaneous psoriasis. 
OBJECTIVE:
To evaluate nail changes in a sample of Iraqi patients with psoriasis and study their association with                the disease severity.
PATIENTS AND METHODS:
The study is a clinico-epidemiological observational cross-sectional study. It was conducted at                       the outpatient clinic at the Center of Dermatology and Venerology/ Medical City Teaching Hospital between May 2018 and August 2019.  A total of 94 patients were enrolled in this study. The severity of psoriasis was assessed using Psoriasis Activity Score Index (PASI), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI) scores whereas the severity of nail involvement was assessed by Nijmegen Nail Psoriasis Activity Index Tool (N-NAIL) and then compared against psoriasis scores. The patients were divided into two groups; patients with (group A) and without (group B) nail involvement.
RESULTS:
The study sample included 41 males (43.62%) and 53 females (56.38%). The mean age at presentation was 32.59±16.32 years. The number of patients in group A was 69 patients (73.4%). The mean ±SD for PASI score was 6.6±7.71 and the mean ±SD for DLQI score was 11.36 ±7.93.While the number of patients in group B was 25 patients (26.6%). The mean ±SD for PASI score was 4.38±3.02 and the mean ± SD for DLQI score was 8.48±4.77.There were no statistical differences between group A and group B regarding age, duration of the disease, PASI score and DLQI score. The patients in group A were subdivided into two groups: the first group included patients with mild psoriasis; 37 patients (PASI score ≤ 10) and the second group included patients with moderate to severe psoriasis; 10 patients (PASI score > 10).The patients with severe cutaneous psoriasis had more severe nail changes. In patients with mild psoriasis, the N-NAIL score was 25.62±23.96 while in patients with moderate to severe psoriasis, the N-NAIL score was 48.8±27.95 (p value =0.011). Crumbling, onycholysis and subungual hyperkeratosis were more frequent in this group. In general, pitting was the most frequently observed finding (52.13%) followed by onycholysis and crumbling.
CONCLUSION:
This is the first study of nail changes in psoriasis patients in Iraq. Nail changes were observed in 73.4% of patients with pitting as the most frequent nail finding. The patients with severe psoriasis had more severe nail changes with higher N-NAIL scores than patients with mild psoriasis.