Comparison of NAPSI and N-NAIL for evaluation of fingernail psoriasis in patients with moderate-to-severe plaque psoriasis treated using ustekinumab.

OBJECTIVE

We sought to determine the psoriatic nail feature which responds to ustekinumab treatment more effectively, and evaluate which between the Nail Psoriasis Severity Index (NAPSI) and the Nijmegen-Nail psoriasis Activity Index tooL (N-NAIL) better reflects the clinical improvement of nail psoriasis.

METHODS

Thirty patients with moderate-to-severe plaque psoriasis were prospectively enrolled and treated with ustekinumab for 52 weeks. A single investigator evaluated the condition using the NAPSI and the N-NAIL with serial fingernail photographs.

RESULTS

Of the 30 patients, 13 (43.3%) had fingernail psoriasis present at baseline. Mean NAPSI scores improved from 9.46 ± 8.7 at baseline to 6.00 ± 5.2 at week 52, but the improvement was not statistically significant (p = .09). Mean N-NAIL scores significantly improved from 5.46 ± 5.1 at baseline to 3.92 ± 3.7 at week 52 (p = .04). Of the psoriatic nail features, only the splinter hemorrhages significantly improved at week 52 compared to baseline.

CONCLUSIONS

When comparing the mean scores between week 0 and 52, the N-NAIL score (p = .04) better reflected a significant improvement of nail psoriasis than the NAPSI (p = .09), and ustekinumab treatment resulted in a more rapid and effective improvement of splinter hemorrhages.