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Challenge of Nail Psoriasis: An Update Review

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Abstract

Nail psoriasis is a refractory disease that affects 50–79% skin psoriasis patients and up to 80% of patients with psoriatic arthritis (PsA). The pathogenesis of nail psoriasis is still not fully illuminated, although some peculiar inflammatory cytokines and chemokines seems to be the same as described in psoriatic skin lesions. Psoriatic nail involving matrix can cause pitting, leukonychia, red spots in lunula, and nail plate crumbling, while nail bed involvement can result in onycholysis, oil-drop discoloration, nail bed hyperkeratosis, and splinter hemorrhages. The common assessment methods of evaluating nail psoriasis includes Nail Psoriasis Severity Index (NAPSI), Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA), Nail Psoriasis Quality of life 10 (NPQ10), and so on. Treatment of nail psoriasis should be individualized according to the number of involving nail, the affected site of nail and presence of skin and/or joint involvement. Generally, topical therapies are used for mild nail psoriasis, while biologic agents such as etanercept are considered for severe nail disease and refractory nail psoriasis. Even though the current literature has shown some support for the pathogenesis, clinical presentation, or therapies of nail psoriasis, systemic review of this multifaceted disease is still rare to date. We elaborate recent developments in nail psoriasis epidemiology, pathogenesis, anatomy, clinical manifestation, diagnosis, differential diagnosis, and therapies to raise better awareness of the complexity of nail psoriasis and the need for early diagnosis or intervention.

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Abbreviations

pDC:

Plasmacytoid dendritic cell

mDC:

Myeloid dendritic cell

ADAMTSL5:

A disintegrin-like and metalloprotease domain containing thrombospondin type 1 motif-like 5

PLA2G4D:

Lipid antigens generated by phospholipase A2 group IVD

LL-37:

Cathelicidin

TNF:

Tumor necrosis factor

Th:

T-helper

IL:

Interleukin

ROS:

Reactive oxygen specie

NETs:

Neutrophil extracellular traps

PNF:

Proximal nail fold

DIP:

Distal interphalangeal

MP:

Middle phalanx

DP:

Distal phalanx

PsA:

Psoriatic arthritis

US:

Ultrasound

PD:

Power Doppler

MRI:

Magnetic resonance imaging

NAPSI:

Nail Psoriasis Severity Index

mNAPSI:

Modified NAPSI

NAPPA:

Nail Assessment in Psoriasis and Psoriatic Arthritis

NPQ10:

Nail Psoriasis Quality of life 10

N-NAIL:

Nijmegen Nail psoriasis Activity Index tool

NB-UVB:

Narrowband ultraviolet B

PUVA :

Psoralen and ultraviolet A

PDL:

Pulsed dye laser

HPCH:

Hydroxypropyl chitosan

FDA:

Food and Drug Administration

AAD/NFP:

American Academy of Dermatology and National Psoriasis Foundation

Fc:

Fragment crystalizable

IgG:

Immunoglobulin G

RCT:

Randomized controlled trial

ROL:

Randomized, open-label study

PCS :

Prospective cohort study

RCS:

Retrospective cohort study

PP :

Plaque psoriasis

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  1. Chao Ji and Haiqing Wang contributed equally to this work.

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  1. Department of Dermatology, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China

    Chao Ji, Haiqing Wang, Chengbei Bao, Liangliang Zhang, Shifan Ruan, Jing Zhang & Bo Cheng

  2. Central Laboratory, the First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350000, Fujian, China

    Ting Gong

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Ji, C., Wang, H., Bao, C. et al. Challenge of Nail Psoriasis: An Update Review. Clinic Rev Allerg Immunol 61, 377–402 (2021). https://doi.org/10.1007/s12016-021-08896-9

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