Scoring nail psoriasis

• Published in: Journal of the American Academy of Dermatology Vol. 70; no. 6; pp. 1061 - 1066
• Main Authors: Klaassen, Karlijn M.G., MD, van de Kerkhof, Peter C.M., MD, PhD, Bastiaens, Maarten T., MD, PhD, Plusjé, Leon G.J.M., MD, Baran, Robert L., MD, Pasch, Marcel C., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2014
• Subjects: Adult; Aged; assessment tool; Dermatology; Female; Humans; Male; Middle Aged; Nail Diseases - diagnosis; Nail Diseases - pathology; nail psoriasis; Nail Psoriasis Severity Index; Nijmegen–Nail Psoriasis Activity Index Tool; Prospective Studies; psoriasis; Psoriasis - diagnosis; Psoriasis - pathology; Psoriasis - psychology; Quality of Life; Reproducibility of Results; Risk Assessment; scoring systems; Sensitivity and Specificity; Severity of Illness Index; Surveys and Questionnaires; Physician Global Assessment; assessment tool; nail psoriasis; psoriasis; ICC; intraclass correlation coefficient; NAPSI; PGA; Nijmegen–Nail Psoriasis Activity Index Tool; N-NAIL; Nail Psoriasis Severity Index; scoring systems
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2014.02.010

Background Scoring systems are indispensable in evaluating the severity of disease and monitoring treatment response. Objective We sought to evaluate the competence of various nail psoriasis severity scoring systems and to develop a new scoring system. Methods The authors conducted a prospective, observational, single-point study of 36 patients given the diagnosis of fingernail psoriasis. Seven scoring systems were evaluated: Nail Psoriasis Severity Index (NAPSI), modified NAPSI, target NAPSI, Psoriasis Nail Severity Score, Nail Area Severity, Baran, and Cannavò et al. All tools were correlated with the Physician Global Assessment. Obtained information was integrated into the Nijmegen–Nail psoriasis Activity Index tooL (N-NAIL), and interrater and intrarater reliability was assessed. Results Physician Global Assessment showed an acceptable correlation with the scoring system designed by Baran ( r  = 0.735, P < .01) and the Psoriasis Nail Severity Score ( r  = 0.734, P < .01). Target NAPSI showed low correlation ( r  = 0.203, P > .05). The correlation between Physician Global Assessment and the N-NAIL was 0.861 ( P < .01). Excellent agreement was found for the intrarater and interrater reliability of the N-NAIL. Limitations Sample size was limited. Conclusion An adequate nail psoriasis scoring system is needed, as studies of treatments for nail psoriasis are on the horizon. Clinical severity of nail psoriasis was best reflected by the N-NAIL, followed by the Baran system and the Psoriasis Nail Severity Score.