Which clinical history findings are characteristic of nail psoriasis?

Updated: Jun 25, 2021
  • Author: Cindy Li, DO; Chief Editor: William D James, MD  more...
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Most psoriatic nail disease occurs in people with clinically evident psoriasis. The diagnosis of psoriatic nail disease without cutaneous psoriasis can be challenging because of the low index of suspicion and the lack of personal/family history of psoriasis.

A retrospective study from 2014 reports that nail involvement in psoriasis is a significant predictor of the patient also having psoriatic arthritis. [4] The study looked at retrospective data from three German cross-sectional independent national studies on patients with psoriasis and psoriatic arthritis. Data on the patient’s history of psoriasis and psoriatic arthritis, clinical findings, nail involvement, and patient- and practitioner-reported outcomes were collected from standardized questionnaires. In the results, the regression model of 4146 patients indicated one of the strongest predictors of concomitant psoriatic arthritis was nail involvement. Balestri et al also suggest nail psoriasis as a risk factor for subclinical psoriatic arthritis, reporting that 50% of subjects with nail psoriasis had interphalangeal stiffness, pain, and swelling. [5]

Choi et al sought to determine whether psoriatic nail features were associated with nail psoriasis or cutaneous psoriasis disease severity. [6] Studies results indicated nail fold psoriasis and subungual hyperkeratosis were significantly associated with disease severity in both cutaneous psoriasis and nail psoriasis.

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