How is nail psoriasis classified?

Updated: Jun 25, 2021
  • Author: Cindy Li, DO; Chief Editor: William D James, MD  more...
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Answer

Answer

Most people with psoriatic arthritis have nail changes that can be classified as follows (see the images below):

  • Type I - Classic distal interphalangeal joint involvement (5% of patients)

  • Type II - Arthritis mutilans

  • Type III - Symmetric polyarthritis

  • Type IV - Asymmetric oligoarthritis (the most common type of psoriatic arthritis, occurring in 70% of patients)

  • Type V - Ankylosing spondylitis

See the images below.

Classic distal interphalangeal joint involvement i Classic distal interphalangeal joint involvement in psoriatic arthritis.
This patient has extensive psoriasis, nail involve This patient has extensive psoriasis, nail involvement, and joint pain.

In 2021, Hudgens et al sought to validate the Physician's Global Assessment of Fingernail Psoriasis using a literature review, pilot cognitive debriefing, concept elicitation, and clinical expert consultations. [9] They suggested this assessment method a valid, rapid, and reliable clinician-rated severity scale and can be used in research and clinical practice.


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