Study Of Nail Changes In Psoriasis

Background: In psoriasis, nail involvement is quite a common phenomenon and the manifestation may range from pitting, Beauâ€s line, leuconychia, onychorrhexis, onycholysis, subungual hyperkeratosis, thinning of nail plate to less commonly splinter hemorrhage, oil drop sign and salmon patch. Objective: To study overall pattern of nail involvement in psoriatic patients along with making a comparison between the patterns of nail changes on finger and toenails and to analyze the association of nail changes with arthropathy and Koebnerâ€s phenomenon. Subjects and settings: One hundred consecutive cases of psoriasis of all age and both sexes were selected for studying the nail changes, in whom diagnosis of psoriasis was made on clinical parameters. KOH preparation was also performed in all cases where onychomycosis was considered a possibility. Results: Thirty six Percent of patients of psoriasis had nail change and fingernails (32%) were more commonly affected than toe nails (24%). Pitting was found to be the most common manifestation in fingernails (65.63%) with significant difference between fingernails and toenails (p<0.001). The frequency of nail changes in psoriasis with joint pain was 73.33% whereas 29.41% in those without joint pain. Chi-square test with Yates correction for the association of nail changes with joint pain gave p value < 0.005 and for the association of nail changes with koebnerâ€s phenomenon p value <0.05. The frequency of nail changes with Koebnerâ€s phenomenon was 56% whereas in those without koebnerâ€s phenomenon it was 29.33%. Conclustion : Pitting was the most common manifestation in fingernails although in toenails subungual hyperkeratosis was the commonest finding. A very strong association was seen between nail changes and joint pain. Association was also strong between nail changes and Koebnerâ€s phenomenon in psoriasis