Onychoscopic Changes in Psoriatic Patients with Skin of Color

Abstract

Background: Nail changes are observed in over half of psoriasis patients and may be associated with significant
morbidity, more severe cutaneous involvement, and an increased risk of psoriatic arthritis. Onychoscopy or
dermoscopy of the nails offers a rapid, non-invasive method for detailed assessment of psoriatic nail abnormalities.
Aims and Objectives: This study aimed to document the onychoscopic findings observed in patients with psoriasis
and determine their correlation with disease severity. Materials and Methods: A cross-sectional observational
study was carried out over 2 months among patients with clinically diagnosed psoriasis attending a tertiary care
hospital. Detailed assessment of cutaneous and nail findings was performed, followed by dermoscopic examination
of all nails using polarized and non-polarized modes (Heine Delta 30™ dermoscope). Statistical processing of
the collected data was performed using IBM Statistical Package for the Social Sciences™ software version 25.0.
Results: A total of 22 patients participated in the study. The most common nail bed abnormality detected on
onychoscopy was onycholysis, seen in 20 (90.9%) of patients. The other common nail bed finding observed was
splinter hemorrhages, which were seen in 13 (59.1%) patients, whereas subungual hyperkeratosis was noted in
5 (22.7%) patients. Salmon patches were seen in 2 (9.1%) of patients. Among nail matrix abnormalities, pitting
was the predominant feature, seen in 11 (50%) patients. This was followed by crumbling or nail plate thickening
seen in 5 (22.7%) of patients each and punctate leukonychia in 2 (9.1%) patients. Overall, 15 (68.2%) patients
had subclinical findings that were missed on clinical examination but picked up on onychoscopy. Nail psoriasis
severity index calculated with the aid of onychoscopy was found to show a statistically significant correlation with
both psoriasis area severity index and % body surface area involvement. Conclusion: Onychoscopy serves as a
useful adjunct in the assessment of psoriatic nail involvement. It can help identify early subclinical nail changes
and thereby accurately quantify the severity of nail involvement.