Comparison of the Objective Severity and the Esthetic Perception of Nail Symptoms in Psoriasis

Nail changes are frequent in psoriasis, and the negative impact of nail psoriasis on patients' quality of life is well known. No data are available however about the association of the objective severity of nail psoriasis and the subjective perception of these symptoms. The purpose of this study was to determine the correlation between the severity of psoriatic nail changes (as determined by the Nail Psoriasis Severity Index [NAPSI]) and the esthetic assessment of nail psoriasis.

Participants (general population and psoriasis patients) were asked to rate 19 nail images (including psoriatic and healthy nails) on a 0-10 scale, based on how disturbing they considered them esthetically. Objective severity (NAPSI) scores of nails were compared to the subjective evaluation values.

Nail symptom severity correlated well with the subjective scores. However, while nails with low (0) and high (6-8) NAPSI values received consistent subjective scores, the esthetic perception of nails with moderate NAPSI scores was rather heterogeneous. The age of the respondents showed robust positive correlation with the subjective assessment of nail symptoms both within the psoriatic and the general population.

Gender, the presence of psoriasis, or medical education had no significant influence on the esthetic assessment of psoriatic nail changes.