PDF(Pubmed)
Abstract：
BACKGROUND: Since during the COVID-19 pandemic nail psoriasis was evaluated exclusively with teledermatology, dermatologists started to face the difficulty in rating it concurrent with other onycopathies (i.e., onychotillomania and onychophagy). Thus, we aimed to improve the existing severity scores and verify the value in different clinical settings (i.e., in person vs. teledermatology (video or picture)).
METHODS: This multicenter prospective observational study evaluated patients with nail psoriasis and screened them for onychophagy or onychotillomania in telemedicine from May 2020 to January 2021. For therapeutic purposes patients with nail psoriasis were followed and rated with the Nijmegen-Nail psoriasis Activity Index tooL (N-NAIL) for 9 months; at the same time, N-NAIL and a new dedicated index that monitor also the changes in nail dimension (Galeazzi-(G) N-NAIL) were tested for accuracy. We assessed inter- and intraobserver agreement for the three different settings (in person, video, and pictures).
RESULTS: In our cohort of 382 patients with nail psoriasis after a clinical and dermatoscopic assessment we found 20 (5.24%) patients with onychophagy and 17 (4.45%) patients with onychotillomania. Analysis of the impact of nail psoriasis on patients revealed that onycholysis and crumbing, followed by subungual hyperkeratosis, were the clinical signs that prevalently bothered patients. N-NAIL score displayed moderate intra- and interobserver agreement. Over the 9 months follow-up, N-NAIL vs. GN-NAIL displayed a solid correlation at all the examined time points, i.e., baseline and after 3, 6, and 9 months.
CONCLUSIONS: We created a new tool, the GN-NAIL capable of efficiently scoring nail psoriasis severity in complex cases, such as patients with onychotillomania and onychophagy, and monitor response to treatment during the COVID-19 pandemic.
METHODS: This multicenter prospective observational study evaluated patients with nail psoriasis and screened them for onychophagy or onychotillomania in telemedicine from May 2020 to January 2021. For therapeutic purposes patients with nail psoriasis were followed and rated with the Nijmegen-Nail psoriasis Activity Index tooL (N-NAIL) for 9 months; at the same time, N-NAIL and a new dedicated index that monitor also the changes in nail dimension (Galeazzi-(G) N-NAIL) were tested for accuracy. We assessed inter- and intraobserver agreement for the three different settings (in person, video, and pictures).
RESULTS: In our cohort of 382 patients with nail psoriasis after a clinical and dermatoscopic assessment we found 20 (5.24%) patients with onychophagy and 17 (4.45%) patients with onychotillomania. Analysis of the impact of nail psoriasis on patients revealed that onycholysis and crumbing, followed by subungual hyperkeratosis, were the clinical signs that prevalently bothered patients. N-NAIL score displayed moderate intra- and interobserver agreement. Over the 9 months follow-up, N-NAIL vs. GN-NAIL displayed a solid correlation at all the examined time points, i.e., baseline and after 3, 6, and 9 months.
CONCLUSIONS: We created a new tool, the GN-NAIL capable of efficiently scoring nail psoriasis severity in complex cases, such as patients with onychotillomania and onychophagy, and monitor response to treatment during the COVID-19 pandemic.
摘要：
背景：由于在COVID-19大流行期间，指甲牛皮癣仅通过皮肤学进行评估，皮肤科医生开始面临困难，很难将其与其他专业医生同时进行评级(即，甲癣和甲癣）。因此，我们旨在改善现有的严重程度评分，并在不同的临床环境中验证其价值(即，在人与远程皮肤病学（视频或图片）。
方法：这项多中心前瞻性观察性研究评估了2020年5月至2021年1月在远程医疗中的指甲牛皮癣患者，并对他们进行了甲癣或甲癣筛查。为了治疗目的，对患有指甲牛皮癣的患者进行随访，并使用奈梅亨-指甲牛皮癣活动指数（N-NAIL）进行9个月的评估；同时，测试了N-NAIL和还监测指甲尺寸变化的新专用指数(Galeazzi-(G)N-NAIL)的准确性。我们评估了三种不同设置的观察者间和观察者间的协议(亲自，视频,和图片）。
结果：在我们的382例指甲银屑病患者队列中，经过临床和皮肤镜检查评估，我们发现20例（5.24%）患者患有甲癣，17例（4.45%）患者患有甲癣。对指甲牛皮癣对患者的影响的分析显示，其次是甲下角化过度,是普遍困扰患者的临床体征。N-NAIL评分显示出适度的观察者内部和观察者之间的一致性。在9个月的随访中，N-NAILvs.GN-NAIL在所有检查的时间点都显示出坚实的相关性，即，基线和3,6和9个月后。
结论：我们创建了一个新工具，GN-NAIL能够在复杂病例中有效评分指甲牛皮癣严重程度，例如患有甲癣和甲癣的患者，并监测COVID-19大流行期间对治疗的反应。
方法：这项多中心前瞻性观察性研究评估了2020年5月至2021年1月在远程医疗中的指甲牛皮癣患者，并对他们进行了甲癣或甲癣筛查。为了治疗目的，对患有指甲牛皮癣的患者进行随访，并使用奈梅亨-指甲牛皮癣活动指数（N-NAIL）进行9个月的评估；同时，测试了N-NAIL和还监测指甲尺寸变化的新专用指数(Galeazzi-(G)N-NAIL)的准确性。我们评估了三种不同设置的观察者间和观察者间的协议(亲自，视频,和图片）。
结果：在我们的382例指甲银屑病患者队列中，经过临床和皮肤镜检查评估，我们发现20例（5.24%）患者患有甲癣，17例（4.45%）患者患有甲癣。对指甲牛皮癣对患者的影响的分析显示，其次是甲下角化过度,是普遍困扰患者的临床体征。N-NAIL评分显示出适度的观察者内部和观察者之间的一致性。在9个月的随访中，N-NAILvs.GN-NAIL在所有检查的时间点都显示出坚实的相关性，即，基线和3,6和9个月后。
结论：我们创建了一个新工具，GN-NAIL能够在复杂病例中有效评分指甲牛皮癣严重程度，例如患有甲癣和甲癣的患者，并监测COVID-19大流行期间对治疗的反应。
