| BACKGROUNDPsoriasis is a chronic recurrent and inflammatory skin disease affecting 0.1-5%of the population.The incidence of the disease is different according to race,environment,geographical location and other factors.The incidence of psoriasis was 0.123%in China in 1984.The epidemiological survey of psoriasis in six provinces and cities in China in 2010 showed that the incidence of psoriasis has increased to 0,47%.Most literatures reported that the incidence of psoriasis was almost same between men and women;some studies showed that men were slightly higher than women,but the difference was not statistically significant.The etiology and pathogenesis of psoriasis is not very clear,it is in the background of multiple genetic fac-tors,induced by environmental factors and immune-mediated inflamma-tory.Infection,stress,trauma,cold,damp and drugs could be the inducing factors of the disease.The incidence rate of nail psoriasis is very high,studies have shown that 10%-78%psoriasis patients had finger(toe)nail damage,and the involvement rate in the life-time of psoriasis patient is probability as high as 80-90%.Nail psoriasis can not only affect the appearance,but also cause a feel-ing of pain,numbness,discomfort,and so on.It could also be the reason of peripheral inflammation and secondary fungal infection.A number of studies have indicated that the discomfort and the esthetic effection caused by nail psoriasis have a significant impact on the psychological and quality of life.Studies have indicated that the area of skin lesions and PASI score of patients with nail psoriasis were higher than that without nail damage,which indicated that nail psoriasis may be a serious risk factor for psoriasis.The chances of getting nail psoriasis are higher in psoriasis patients whose PASI score>12,so more severe psoriasis and nail psoriasis seem to be re-lated.Although the incidence of nail psoriasis rate is very high,and it can cause significant damage,but,nail psoriasis,as one of the important clinical features of psoriasis,is often been ignored,and comprehensive study of nail psoriasis is hard to find.Now the psoriatic lesion area and severity index—PASI score has been used as a commonly used means for quantitative assessment of psoriatic le-sions,also,a unified criterion is needed to assess the severity and therapeutic response of psoriasis.The most commonly used scoring system is the nail psoriasis severity index(NAPSI),and other scor-ing systems include modified NAPSI,target NAPSI,and Psoriasis Nail Severity Score(PNSS),Nail Area Severity(NAS),Baran score,Cannavo score,Physician Global Assessment(PGA),etc.These scoring methods based on different manifestations of nail psoriasis have their own advantages and disadvantages,but unfortunately,there is no interna-tionally recognized scoring system.Nowadays,more and more attention has been paid to nail psoriasis,and more and more studies have been carried out on the epidemiology and treatment response of nail psori-asis at home and abroad.Most studies only focus on some aspects of nail psoriasis,such as epidemiology,clinical types,treatment re-sponses and so on.It is difficult to find more comprehensive re-search data.Some of the studies are only small sample studies,and it is not very convincing.There are few clinical studies on nail psoriasis in China,and no clinical studies on assessment of the se-verity of nail psoriasis have been retrieved.In order to comprehen-sively research the clinical characteristics of psoriasis inpatients,we designed this study to obtain comprehensive clinical data for the diagnosis and treatment of nail psoriasis.Part one CLINICAL ANALYSIS ON PSOR AS S INPATIENTS OBJECTIVE The purpose of this study is to research the characteristics and clinical features of psoriasis in Shandong Province,and to study the incidence and clinical types of nail psoriasis.To early detect the predisposing factors and risk factors of psoriasis,and provide the theoretical basis for improving the quality of life and the comprehensive efficacy of treatment.METHOD 1.Collect the basic data of 481 psoriasis inpatients from April 2013 to March 2014 in Dermatological Hospital Affiliated to Shandong University.2.Diagnostic criteria:All cases met the clinical diagnosis and treatment criteria of psoriasis in the fourth edition of China Clinical Dermatology edited by Zhao Bian.The diagnosis of nail psoriasis conformed to the characteristic nail lesion of psoriasis.The diagnosis of psoriasis and psoriasis was made by more than two experienced dermatologists.3.Calculate the percentage of lesions area of psoriatic inpatients and calculate the PAST score.4.SPSS 21.0 statistical software was used for statistical analysis.RESULT1.A total of 481 psoriasis inpatients were collected,with a male to female ratio 2.88:1.29.94%of the patients had a family history.433 cases were adult psoriasis(90.02%).27.44%of those had a history of smoking and 11.64%had a history of drinking.10.40%of the patients had hypertension.2.42.00%patients had initial skin lesions on the head,42.62%had no obvious inducement,22.25%had upper respiratory tract infection,The main causes of recurrence and aggravation of disease were climate changes(69.44%),upper respiratory tract infection(45.95%)and stress factors(29.31%).64.24%of the patients had fascicular hair,26.61%had furrowed tongue,fascicular hair and furrowed tongue were positively correlated with PASI.86.28%of patients had itching of varying degrees,and 69.23%of them had mild or moderate itching.The itching score was positively correlated with PASI score(r=0.20,P<0.01).3.375 cases(77.96%)were psoriasis vulgaris,45 cases(9.36%)were psoriasis arthropathy,36 cases(7.48%)were psoriasis erythroderma,8 cases(1.67%)were pustular psoriasis,and 17 cases were complicated with more than two types of severe psoriasis.4.Among 481 cases of psoriasis,346 cases had nail lesions,58 cases were confirmed as onychomycosis by fungal microscopy and culture,274 cases were nail psoriasis,and the incidence of nail psoriasis was 56.96%.The incidence of nail psoriasis varied greatly among different types of psoriasis.The incidence of nail psoriasis was 49.07%in psoriasis vulgaris inpatients,86.67%in psoriasis arthropathy,and 88.24%in patients with mixed severe psoriasis.5.Among 274 patients with nail psoriasis,the most common nail lesion was pitting(52.19%),followed by nail onycholysis(42.70%),and the third was hyperkeratosis(37.97%).splinter hemorrhages(21,17%),oil drop(salmon patch)dyschromia(20.44%),nail plate crumbling(13.87%),leukonychia(12.77%)and red spots in the lunula(0,36%)followed them.The most common type of nail damage among psoriasis vulgaris and psoriatic arthritis was pitting(55.98%in PV and 53.85%in PSA).The most common lesions of psoriasis pustular were pitting and nail plate crumbling(66.67%).In the psoriasis erythroderma,nail plate crumbling was the most common deamage(56.67%).CONGLUS ON1.There are more male psoriasis inpatients than female.About 30%of the patients have a familiy history of psoriasis.2.In most cases,scalp is the initial site.Most patients have no obvious predisposition at first onset,and the upper respiratory tract infection is the most common inducement.Seasons,followed by upper respiratory tract infection and stress factors are related to the recurrence and aggravation of psoriasis.The incidence of fascicular hair and furrowed tongue was relatively high,and is parallel to the disease severity.Patients with severe skin lesions suffer more obvious itching.3.The incidence of nail psoriasis is very high in psoriasis inpatients and more higher in severe types of psoriasis.Among the patients with nail psoriasis,the most common nail changes is pitting,the incidence is 52.2%.The most common nail damage is pitting in psoriasis vulgaris and psoriatic arthritis,pitting and nail plate crumbling in psoriasis pustular,and nail plate crumbling in psoriasis erythrodermic.PART TWO CLINICAL STUDY ON NAIL PSORIASIS INPATIENTSABJECTIVETo analyse the incidence,clinical characteristics of nail psoriasis.To analyse the relationship between nail psoriasis and psoriasis severity and to analyse the clinical significance of Nail Psoriasis Severity Index(NAPSI)in adult psoriasis vulgaris inpatients.To expolre a new and easier scoring system for nail psoriasis.To provide evidence for early detection of the predisposing and provocative factors of nail psoriasis,then to improve the quality of life and the comprehensive efficacy of t reatment.METHOD1.Collected the basic data of 279 adults psoriasis vulgaris inpatients in Dermatological Hospital Affiliated to Shandong University from April 2013 to March 2014.2.Diagnostic Criteria:All cases met the clinical diagnosis and treatment criteria of psoriasis in the fourth edition of China Clinical Dermatology edited by Zhao Bian.The diagnosis of psoriasis conformed to the characteristic nail lesion of psoriasis.The diagnosis of psoriasis and nail psoriasis was made by more than two experienced dermatologists.3.Collected the data:course of disease,symptoms,number of damaged nails and types of nail psoriasis,then took nail photographs.Patients with nail damage underwent mycological examination to exclude onychomycosis.4.Calculate the percentage of body surface area of psoriasis inpatients and calculate the PASI value.Calculate NAPSI and PGA score.5.Design a new simple scoring system to evaluate the severity of psoriasis:SNPSS.6.SPSS 21.0 statistical software was used for statistical analysis.RESULTS1.The incidence of nail psoriasis in adult psoriasis vulgaris inpatients was 59.50%,and there was a higher incidence in male than female(64.45%vs 44.12,p<0.01).2.The median duraton of nail psoriasis was 12 months.The onset age of psoriasis was 28.55 ± 13.74 years old(median 26)in nail psoriasis patients,and that of non-nail psoriasis was 23.73 ±12.18(median 21).There was a significant difference between two groups(p<0.01).The onset age of lesion was later in nail psoriasis patients than that of non-nail demage patients.3.Logistic regression analysis showed that smoking,late onset of skin lesions and PASI)12 were risk factors for nail psoriasis,the OR values were 3.47,2.77 and 1.82 respectively.4.The most common type of nail damage was pitting,accounting for 60.24%,followed by onycholysis,accounting for 53.01%.The others were:nail bed hyperkeratosis 31.33%,splinter hemorrhages 27.71%,oil drop(salmon patch)dyschromia 25.,30%,leukonychia 16,87%,nail plate crumbling 8.43%.Red spots in the lunula was not found.The number of damaged fingernails was 6.02+3.85,and the number of toenails was 3.66+3.56.The number of nail damage was significantly correlated with duration of psoriasis and duration of nail damage.7.23%patients had symptoms of pain,and 2.41%of them had symptoms of numbness.20.48%of the patients had nail fold involvement.5.There were significant differences in lesion area,PASI score,age and the first onset age between patients with and without nail damage.Lesion area,PASI score,age in patients with nail psoriasis were higher than those without nail disease,the first onset age was older.6.Mean NAPSI of nails was 14.84+13.19,mean NAPSI of toenails was 8.90±10.53,and the total NAPSI score was 23.70±20.62.NAPSI was significantly correlated with duration of psoriasis,PASI score,number of finger nail damage,number of toe nail damage,and duration of nail damage.7.Simple nail psoriasis severity score:NAPSS score was 17.53+10.90,SNPSS and NAPSI were significantly correlated,r= 0.79,P<0.01.SNPSS was related to PASI,r=0.55,p=0.03.No correlation was detected between SNPSS and lesion area,the course of psoriasis and the course of nail disease.CONCLUS ON1.There is a high incidence of nail psoriasis in adult psoriasis vulgaris inpatients,and the incidence in male is higher than in female.2.The median duration of nail psoriasis is 1 year.Patients with nail psoriasis are older,the first onset time is later and the condition of psoriasis is more serious.3.The risk of developing nail psoriasis is increased in patients with a history of smoking,late onset of skin lesions and PASI score?12.4.The most common type of nail psoriasis is pitting,followed by onycholysis and hyperkeratosis.On average,6 finger nails and 4 toe nails are involved in every patient,and the number is increased in patients with a long durtion of psoriasis and nail psoriasis.Some patients have symptoms of nail fold involvement,pain and numbness,nail fold involvement is related with duration of psoriasis and some types of nail damage.5.NAPSI score is related to the course of psoriasis and PASI score,and can be used as an indicator for the severity of nail psoriasis.6.SNPSS is significantly correlated with NAPSI,and correlated with PASI.It is reliable,accurate and simple,so it can be used as a simple index to evaluate the severity of nail psoriasis. |
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