Scoring nail psoriasis

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 Cannavo 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 r  = 0.734, P r  = 0.203, P > .05). The correlation between Physician Global Assessment and the N-NAIL was 0.861 ( P 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.