ReportNail psoriasis severity index: a useful tool for evaluation of nail psoriasis☆
Section snippets
Methods
In an attempt at informal assessment of the reproducibility of the NAPSI score, 37 dermatologists were asked to evaluate 8 psoriatic nails using the NAPSI. All of the nails in Fig 1, Fig 2, Fig 3, Fig 4, Fig 5 were among the 8 nails graded. The physicians were briefly instructed in the use of the NAPSI score and used a standard NAPSI grading sheet (Fig 1, C) to evaluate the same 8 psoriatic nails projected on a screen. The physicians graded the psoriatic nails for nail bed and nail matrix
Results
The graphs in Figs 2, B, through 5, B, show the number of dermatologists who assigned a particular score to that nail. Again, it is not our intention to imply statistical validation but to suggest that there is a trend toward reasonable reproducibility among physicians grading the same nails. Additional studies are needed to ascribe statistical significance and validation to the NAPSI scale.
Discussion
Many studies in the literature have evaluated the effectiveness of various therapies for nail psoriasis.5, 6, 7, 8, 9, 10, 11, 12, 13, 14 Most of these studies assessed clinical improvement in a global manner, and some evaluated clinical psoriatic features in a target nail. Many clinical features of nail psoriasis were used in the grading of nails in these studies. For example, the study by Tosti et al15 of calcipotriol in nail psoriasis used precise measurements of nail thickness. Pierard et al
Conclusion
Objective measurement of clinical improvement or worsening of nail psoriasis is of value in guiding medical therapy and standardizing clinical trials. Good agreement of scoring with the NAPSI was found among 37 dermatologists. Knowing which features of nail psoriasis respond to a particular therapy helps individualize nail psoriasis treatment. The NAPSI is a scale that was simple to calculate, sensitive to changes (improvement and worsening), and reproducible among 37 dermatologists in our
Acknowledgements
We acknowledge the generous help and critique of Dr. Mark Lebwohl and Arnold Cavanaugh in the preparation of the NAPSI scale. We thank the members of Oregon Dermatology Society for testing the scale.
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Funding sources: None.
Conflict of interest: None identified.