Keywords : Psoriasis

Nail Changes in Psoriatic Patients and their Association with Disease Severity

Zahraa Saeed Al-Taie; Hayder Raouf Al-Hamamy

Iraqi Postgraduate Medical Journal, 2021, Volume 20, Issue 3, Pages 240-247
DOI: 10.52573/ipmj.2020.169714

Nail psoriasis occurs in both adults and children. Nail involvement is associated with significant physical and psychological consequences for a substantial number of patients. The prevalence of nail changes among patients with psoriasis varies between 10 and 55 percent. In most patients, nail involvement follows or is concurrent with onset of cutaneous psoriasis. 
To evaluate nail changes in a sample of Iraqi patients with psoriasis and study their association with                the disease severity.
The study is a clinico-epidemiological observational cross-sectional study. It was conducted at                       the outpatient clinic at the Center of Dermatology and Venerology/ Medical City Teaching Hospital between May 2018 and August 2019.  A total of 94 patients were enrolled in this study. The severity of psoriasis was assessed using Psoriasis Activity Score Index (PASI), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI) scores whereas the severity of nail involvement was assessed by Nijmegen Nail Psoriasis Activity Index Tool (N-NAIL) and then compared against psoriasis scores. The patients were divided into two groups; patients with (group A) and without (group B) nail involvement.
The study sample included 41 males (43.62%) and 53 females (56.38%). The mean age at presentation was 32.59±16.32 years. The number of patients in group A was 69 patients (73.4%). The mean ±SD for PASI score was 6.6±7.71 and the mean ±SD for DLQI score was 11.36 ±7.93.While the number of patients in group B was 25 patients (26.6%). The mean ±SD for PASI score was 4.38±3.02 and the mean ± SD for DLQI score was 8.48±4.77.There were no statistical differences between group A and group B regarding age, duration of the disease, PASI score and DLQI score. The patients in group A were subdivided into two groups: the first group included patients with mild psoriasis; 37 patients (PASI score ≤ 10) and the second group included patients with moderate to severe psoriasis; 10 patients (PASI score > 10).The patients with severe cutaneous psoriasis had more severe nail changes. In patients with mild psoriasis, the N-NAIL score was 25.62±23.96 while in patients with moderate to severe psoriasis, the N-NAIL score was 48.8±27.95 (p value =0.011). Crumbling, onycholysis and subungual hyperkeratosis were more frequent in this group. In general, pitting was the most frequently observed finding (52.13%) followed by onycholysis and crumbling.
This is the first study of nail changes in psoriasis patients in Iraq. Nail changes were observed in 73.4% of patients with pitting as the most frequent nail finding. The patients with severe psoriasis had more severe nail changes with higher N-NAIL scores than patients with mild psoriasis.

Efficacy of Etanercept Treatment in Iraqi Patients with Moderate to Severe Psoriasis

Iraqi Postgraduate Medical Journal, 2020, Volume 19, Issue 1, Pages 9-15

Etanercept is a tumor necrosis factor (TNF) α inhibitor that has been approved for the treatment
Assessing the efficacy of etanercept therapy in Iraqi patients with moderate to severe psoriasis.
This study was a therapeutic interventional study at Medical City; center of dermatology and
venereology (Baghdad, Iraq) from January 2017 till June 2018, with 53 patients, 31 (58.49%) males
and 22 (41.51%) females, with 51 patients having moderate to severe plaque psoriasis and 2 patients
with pustular psoriasis. All patients were given 50 mg subcutaneous injection of etanercept twice
weekly for 3 months, followed by single injection of etanercept weekly for the next 9 months.
Psoriasis area and severity index calculations were done every 3 months until 1year of treatment.
The baseline PASI score changed from a mean ± standard deviation of 24.28 ± 14.56 to 1.62 ± 3.11
At the end of 12 months of treatment with a significant difference (P=0.001). Regarding the
reduction in the patients' PASI score: At 3 months of treatment, (71.4%) achieved PASI 50, (48.2%)
had PASI 75, and (5.35%) had PASI 90, at the 12th month of treatment (75.4%) reached PASI 90,
(86.79%) reached PASI 75, &(94.33%) had PASI 50. Side effects were mild and tolerable.
Etanercept is an effective therapy in treating moderate to severe psoriasis with tolerable side effects.