Clinical and Ultrasonographic Assessment of Nail Psoriasis: A Comprehensive Study

Introduction: In patients with plaque type psoriasis (PSO), the progression to psoriatic arthritis (PsA) exacerbates the disease's impact and increases disability risk. Nail psoriasis (NP) affects up to 90% of PSO patients with a wide spectrum of clinical features and is a significant predicto...

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Main Authors: Maria Esposito, Lina Maria Magnanimi, Paolo Antonetti, Andrea De Berardinis, Cristina Pellegrini, Emanuele Vagnozzi, Manfredo Bruni, Camilla Gianneramo, Paola Cipriani, Maria Concetta Fargnoli, Antonio Barile, Piero Ruscitti
Format: Article
Language:English
Published: Mattioli1885 2025-07-01
Series:Dermatology Practical & Conceptual
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Online Access:https://dpcj.org/index.php/dpc/article/view/5318
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author Maria Esposito
Lina Maria Magnanimi
Paolo Antonetti
Andrea De Berardinis
Cristina Pellegrini
Emanuele Vagnozzi
Manfredo Bruni
Camilla Gianneramo
Paola Cipriani
Maria Concetta Fargnoli
Antonio Barile
Piero Ruscitti
author_facet Maria Esposito
Lina Maria Magnanimi
Paolo Antonetti
Andrea De Berardinis
Cristina Pellegrini
Emanuele Vagnozzi
Manfredo Bruni
Camilla Gianneramo
Paola Cipriani
Maria Concetta Fargnoli
Antonio Barile
Piero Ruscitti
author_sort Maria Esposito
collection DOAJ
description Introduction: In patients with plaque type psoriasis (PSO), the progression to psoriatic arthritis (PsA) exacerbates the disease's impact and increases disability risk. Nail psoriasis (NP) affects up to 90% of PSO patients with a wide spectrum of clinical features and is a significant predictor of enthesitis, often associated with early PsA stages. Objective: This study aimed to clinically and ultrasonographically evaluate nail units in PSO patients, focusing on differences between those with/without PsA and those with/without onychopathy. Methods: Sixty patients were enrolled (23/60 PSO-37/60 PSO and PsA). PSO and PsA patients were evaluated and compared as well as patients with/without diagnosis of nail psoriasis in this cross-sectional single-center study. Nail abnormalities were evaluated by high frequency ultrasound (HFUS) using high frequency probes (27 MHz). After a descriptive assessment, the Nail Psoriasis Severity Index (NAPSI) and the Brown University Nail Enthesis Scale (BUNES) were used to clinically and ultrasonographically assess nails. Results: HFUS evaluation identified a spectrum of nail and blood flow alterations. Nail disease was characterized by median NAPSI 16 (range 28), median BUNES morphometry 1.5 (range 0.9), and median BUNES power Doppler (PD) 2.2 (range 4.03). Among the studied sample, 43/60 (71.7%) presented nail psoriasis, with 69.7% presenting coexisting PsA as compared to PSO patients (30.3%) (p = 0.04). Conclusion: Our findings highlight the importance of close collaboration between dermatologists and rheumatologists in the evaluation of PSO patients, taking advantage of both clinical and ultrasonographic assessment of nail damage.
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spelling doaj-art-23627600d11b4e7fa732c638fbc7ad2a2025-08-20T03:06:20ZengMattioli1885Dermatology Practical & Conceptual2160-93812025-07-0115310.5826/dpc.1503a5318Clinical and Ultrasonographic Assessment of Nail Psoriasis: A Comprehensive StudyMaria Esposito0Lina Maria Magnanimi1https://orcid.org/0000-0003-2056-9483Paolo Antonetti2Andrea De Berardinis3Cristina Pellegrini4Emanuele Vagnozzi5Manfredo Bruni6https://orcid.org/0000-0001-9357-9653Camilla Gianneramo7Paola Cipriani8Maria Concetta Fargnoli9Antonio Barile10Piero Ruscitti11Biotechnological and Applied Clinical Sciences - University of L'AquilaDepartment of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, ItalyDermatology Unit, San Salvatore Hospital, L’Aquila, ItalyDepartment of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, ItalyDepartment of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, ItalyDepartment of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, ItalyDepartment of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, ItalyDepartment of Emergency and Interventional Radiology, San Salvatore Hospital, L’Aquila, ItalyDepartment of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, ItalyDepartment of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, ItalyDepartment of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, ItalyDepartment of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy Introduction: In patients with plaque type psoriasis (PSO), the progression to psoriatic arthritis (PsA) exacerbates the disease's impact and increases disability risk. Nail psoriasis (NP) affects up to 90% of PSO patients with a wide spectrum of clinical features and is a significant predictor of enthesitis, often associated with early PsA stages. Objective: This study aimed to clinically and ultrasonographically evaluate nail units in PSO patients, focusing on differences between those with/without PsA and those with/without onychopathy. Methods: Sixty patients were enrolled (23/60 PSO-37/60 PSO and PsA). PSO and PsA patients were evaluated and compared as well as patients with/without diagnosis of nail psoriasis in this cross-sectional single-center study. Nail abnormalities were evaluated by high frequency ultrasound (HFUS) using high frequency probes (27 MHz). After a descriptive assessment, the Nail Psoriasis Severity Index (NAPSI) and the Brown University Nail Enthesis Scale (BUNES) were used to clinically and ultrasonographically assess nails. Results: HFUS evaluation identified a spectrum of nail and blood flow alterations. Nail disease was characterized by median NAPSI 16 (range 28), median BUNES morphometry 1.5 (range 0.9), and median BUNES power Doppler (PD) 2.2 (range 4.03). Among the studied sample, 43/60 (71.7%) presented nail psoriasis, with 69.7% presenting coexisting PsA as compared to PSO patients (30.3%) (p = 0.04). Conclusion: Our findings highlight the importance of close collaboration between dermatologists and rheumatologists in the evaluation of PSO patients, taking advantage of both clinical and ultrasonographic assessment of nail damage. https://dpcj.org/index.php/dpc/article/view/5318nail psoriasis High Frequency UltrasoundPsoriatic ArthritisPsoriasis Diagnosis
spellingShingle Maria Esposito
Lina Maria Magnanimi
Paolo Antonetti
Andrea De Berardinis
Cristina Pellegrini
Emanuele Vagnozzi
Manfredo Bruni
Camilla Gianneramo
Paola Cipriani
Maria Concetta Fargnoli
Antonio Barile
Piero Ruscitti
Clinical and Ultrasonographic Assessment of Nail Psoriasis: A Comprehensive Study
Dermatology Practical & Conceptual
nail psoriasis
High Frequency Ultrasound
Psoriatic Arthritis
Psoriasis Diagnosis
title Clinical and Ultrasonographic Assessment of Nail Psoriasis: A Comprehensive Study
title_full Clinical and Ultrasonographic Assessment of Nail Psoriasis: A Comprehensive Study
title_fullStr Clinical and Ultrasonographic Assessment of Nail Psoriasis: A Comprehensive Study
title_full_unstemmed Clinical and Ultrasonographic Assessment of Nail Psoriasis: A Comprehensive Study
title_short Clinical and Ultrasonographic Assessment of Nail Psoriasis: A Comprehensive Study
title_sort clinical and ultrasonographic assessment of nail psoriasis a comprehensive study
topic nail psoriasis
High Frequency Ultrasound
Psoriatic Arthritis
Psoriasis Diagnosis
url https://dpcj.org/index.php/dpc/article/view/5318
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